DB TERM Research: Team Cohesion.... I included articles, you don't have to use my articles. 400 words.
intellects
topic_team_cohesion_400_words.docBUSI 340
Discussion Board Instructions
The learning theories, upon which this course is based, are actualized in the Discussion Board Forums. At the beginning of each module/week, you will choose a key term to research. You will be required to write a thread of at least 400 words on the topic, complete with page references and specifics to document the response, and post it to the corresponding Discussion Board Forum. Correct use of English and grammar are required.
Additionally, you will be required to post a substantive written reply of a minimum of 200 words to at least 3 classmates’ Discussion Board threads.
To complete your thread:
1. Select a key term from assigned chapters. Team Cohesion
2. Terms cannot be duplicated; therefore, reserve it as a topic on the Discussion Board Forum by posting a thread with only the term in the subject line. Topics can be reserved beginning at 12:01 a.m. (ET) on Monday of Modules/Weeks 1, 3, 5, and 7. Topic reservations posted earlier will be deleted.
3. Conduct an Internet search to find and read 3 recent articles that relate to the term .
4. Select the 1 article that you wish to discuss.
5. Post a new thread that contains the following information in the following format, using the headers so that you ensure that all aspects of the assignment are completed as required. Failure to follow these instructions will result in a 1-point deduction.
a. Definition : Give a brief definition of the key term followed by the APA reference for the term; this does not count in the 400-word requirement .
b. Summary: Give a brief summary of the selected article, in your own words.
c. Discussion :
Give a brief discussion of how the article relates to the selected chapter key term. This gives you the opportunity to add value to the discussion by sharing your experiences, thoughts, and opinions. Draw your peers into discussion of topics by asking questions. This is the most important part of the posting! Most of your discussion section should be based upon scholarly researches sources. Opinions can be a very small supplement to the literature base.
i. Include the complete URL of each article (use a persistent link for articles from the Liberty University Online Library ) in APA-reference format of each article read. These do not count toward the 400-word requirement.
6. Click here for assistance with APA formatting .
To complete your replies:
1. Read the postings of your peers and the articles which are referenced (This is why it is imperative that the articles be accessible via working URL links). Expect to spend some time each day reviewing all threads and replies, even those in which you are not involved.
2. Write at least 200 words to 3 or more classmates’ threads. You should expect to answer questions posed within each discussion thread. Student interaction is key to success in this course.
Grading
Consult the accompanying document to see a rubric for how your instructor will grade this assignment. Note that late postings will receive zero credit. Also, any form of plagiarism, including cutting and pasting, will result in zero points for the entire assignment, plus a required 500-word written paper on the topic of plagiarism in order to receive credit for this assignment.
Tips
Articles may be found in the Wall Street Journal, Financial Times, the Economist, or any other reputable website that deals with business . You will be performing academic research, which utilizes reliable sources of information from reputable magazines or newspapers that are available in electronic format or hard copy.
Sites that are absolutely not acceptable are:
· Wikipedia
· About.com
· Commercial sites (usually a consultant's web page, but may take other forms)
· Blogs (be careful, some look very convincing)
· Education sites (these usually do not contain articles, but rather lecture notes or student papers)
You can utilize the Liberty University Online Library portal for research, but note that some articles may not offer persistent links. If you utilize articles found in LexisNexis or other sites that are behind security walls, you will need to make the articles available to classmates by copying and pasting into a Word document and attaching the document to the thread. If this is done, be sure that you include the APA-formatted references included at the bottom of the Discussion Board posting. This is easily accomplished by saving all articles to a folder and then making the folder a zip file. The zip file can then be attached to the Discussion Board submission. Here is a link to the Liberty University Online Library .
The availability of the articles that you research regarding the topic is important because classmates must be able to read the articles to form their own opinions and gain further insight into the topic. Students need to understand not merely the key terms but also how to research reliable sources. This is not only to further their education, but also for their professional use.
Discussion Board Example
Groupthink
Definition: Organizational Behavior notes, “Groupthink is the tendency of highly cohesive groups to value consensus at the price of decision quality” (McShane & Von Glinow, 2008, p. 257).
Summary: The article entitled “The Turn to Online Research is Narrowing the Range of Modern Scholarship, a New Study Suggests” written by Rebecca Tuhus-Dubrow discusses how the internet has made accessing research and other things on the internet extremely easy. By using search engines this has caused groupthink for many students conducting research. (Instructor Note: This is a shorter summary. Do not feel like you have to limit yourself to this length in the summary section.)
Discussion: The internet has made performing research for students a matter of seconds. Students used to have to go to the library and conduct research out of textbooks and other publications but now by simply typing your subject in a search engine a variety of choices are at your fingertips. “Millions of journal articles are available online, enabling scholars to find material they never would have encountered at their university libraries” (Tuhus-Dubrow). A recent study by James Evans, a sociologist at the University of Chicago, has “determined that as more journal issues came online news papers referenced a relatively smaller pool of articles which tended to be more recent, at the expense of older and more obscure work” (Tuhus-Dubrow).
The internet just like everything else has it costs as well as benefits. Just like the article states the internet has started to dominate people’s lives. People rely on the internet for everything for both work and personal use. “Our daily experience- what we watch, listen to, and read; the people we date and the friendships we maintain—is increasingly shaped by the vast information landscape of the internet, and how it is filtered for personal use” (Tuhus-Dubrow).
The internet is considered to be a new form of groupthink because when searching for articles students are not highly selective in the choices they make and they tend to pick one of the few search choices that comes up. Also, the other alternatives of research are now not used due to the convenience of the internet. “Search engines must present results in some kind of order and most sites rely on tools that rank results primarily in two ways: in reverse chronological order and by popularity” (Tuhus-Dubrow). If a search engine filters results by popularity then this is groupthink because others are succumbing to the will of the group by choosing the same articles that show up first as results.
Do you feel that internet search engines cause groupthink? If so, elaborate on why you think this. Do you feel that this is why many professors at Liberty University want students to not choose the same discussion board topics? I personally feel that the reason professors want us to chose different topics is so that we will not reflect the same views and chose the same articles which would therefore be groupthink.
References
Adler, S. (2009). At davos, beware the tide of groupthink. Bloomberg Businessweek. Retrieved from: http://www.businessweek.com/bwdaily/dnflash/content/feb2009/db2009021_878209.htm
McShane, S., & Von Glinow, M.A. (2013). Organizational behavior (6th ed.). New York: McGraw-Hill.
Mulrine, A. (2008). The army trains a skeptics corps to battle groupthink. US News. Retrieved from: http://www.usnews.com/articles/news/world/2008/05/15/the-army-trains-a-skeptics-corps-to-battle-groupthink.html
Tuhus-Dubrow, R. (2008). Group think: The turn to online research is narrowing the range of modern scholarship, a new study suggests. Boston.com. Retrieved from: http://www.boston.com/bostonglobe/ideas/articles/2008/11/23/group_think/
Definition of Team Cohesion
co·he·sion
noun
1. the act or state of cohering , uniting, or sticking together.
2. Physics. the molecular force between particles within a body or substance that acts to unite them. Compare adhesion ( def 4 ) .
3. Botany . the congenital union of one part with another.
4. Linguistics . the property of unity in a written text or a segment of spoken discourse that stems from links among its surface elements, as when words in one sentence are repeated in another, and especially from the fact that some words or phrases depend for their interpretation upon material in preceding or following text, as in the sequence Be assured of this. Most people do not want to fight. However, they will do so when provoked, where this refers to the two sentences that follow, they refers back to most people, do so substitutes for the preceding verb fight, and however relates the clause that follows to the preceding sentence. Compare coherence ( def 5 ) .
Origin: 1670–80; variant of cohaesion < Latin cohaes- (variant stem of cohaerēre to cohere ) + -iōn- -ion
http://dictionary.reference.com/browse/cohesion
1. Team Cohesion
You can be the most talented team in the world and still fail if you lack team cohesion. Also known as teamwork, team cohesion is an active process where players come together to achieve a common goal and remain united in pursuit of that objective.
The Great Bambino once said:
“The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don’t play together, the club won’t be worth a dime.” – Babe Ruth
In order for teams to reach their true potential every player must commit to working hard with their teammates for the good of the team and not the individual. You will not be successful in team sports if you do not work with and support each member of your team.
There is nothing worse in sports than a team with great potential that doesn’t get along. Players need to have each others backs on and off the field to overcome adversities and grow as a unit. Consider the following two scenarios:
Scenario 1:
Smalls is a new in town decides to join the baseball team to make friends before school starts. During the first practice other players laugh and make fun of him when he makes mistakes. Smalls never played competitive baseball before, but none of his teammates offer to help him, because they are all worried about their own games.
Outside of baseball the team gets together at the pool, the fair, and has camp-outs, but no one invited Smalls. As a result Smalls keeps to himself, lacks motivation to get better, and constantly worries about making mistakes. Eventually this causes him to quit – leaving the team them with only eight players. When it comes time to play their rivals the Tigers they have to forfeit – ending their season due to a lack of players.
Scenario two:
Smalls is new in town and decided to join the baseball team to make friends before school starts. During the first practice other players laugh and make fun of him when he makes mistakes. Benny the team captain sees this and tells the others to back off and give him a chance. After practice Benny walks Smalls home and gives him some tips.
The next day Smalls meets Benny at the field early to go over some drills before practice. When arrives they are shocked by how much Smalls has improved. They follow Benny’s lead and teach smalls how to play the game. Throughout the summer they team continues to improve and develop a bond on and off the field.
In the big game against the Tigers, each player shows up prepared to contribute to the team success. When Smalls is in a pickle, his teammates come together and rally behind him. When it comes time to step up Benny assumed the leadership role and lead his team to victory.
Athlete Tips for Team Success
1. Lead by example and help players who struggle to fit in. At some point in your career someone was willing to help you. It isn’t just the coach’s job to help players improve. Some athletes respond better to peer instruction. By helping other players you make the team stronger and become a leader.
2. Include everyone in team activities. This will help develop a bond between you and your teammates. Remember you aren’t competing against members of your team, you are competing with them. Each player has a specific role for the greater good of the team. In the second scenario, each player committed to their role to help the team succeed, and that’s what being a winning team is all about.
http://www.sportpsychologytoday.com/youth-sports-psychology/team-cohesion-determines-team-success/
Tags: Baseball , sports , Team Cohesion Written by Mike Edger , Posted in Articles for Athletes , Sports Psychology , Youth Sports Articles
53
Journal of Sport Management, 2012, 26, 53-66
© 2012 Human Kinetics, Inc.
URL http://www.humankinetics.com
Warner is with the Sport Management Program, East Carolina
University, Greenville, SC, and the Sport and Life Quality Lab,
The University of Texas at Austin, Austin, TX. Bowers and
Dixon are with the Sport Management Program, The University
of Texas at Austin, Austin, TX.
Team Dynamics: A Social Network Perspective
Stacy Warner, Matthew T. Bowers, and Marlene A. Dixon
The University of Texas at Austin
Research has consistently revealed that team cohesion is positively related to team performance under certain
conditions. In response to the need for understanding this relationship more fully, and because of the promising
new insights that can be garnered with the use of social network analysis (SNA), this study employs SNA
as a tool to explore a case study of the structural cohesiveness of two women’s collegiate basketball teams.
Members of the two teams completed online roster-based surveys related to different types of structural cohesion
levels at four points during the season. This case study revealed that the higher performing team showed
improved structural cohesion in the efficacy network over the four phases, and highlighted the movement of
key players in the different networks (friendship, trust, advice, and efficacy) over time. These patterns demonstrate
the potential for SNA to function as a diagnostic tool for organizations and researchers to generate
testable hypotheses even in instances where statistical inference may be precluded by sampling constraints.
In short, SNA was found to be a valuable new tool for exploring, depicting, and informing explanations about
the individual relationships that impact team dynamics.
Dynamics of Team Cohesion:
A Social Network Perspective
While tangible factors are easier to identify and
measure, intangible factors are frequently a critical determinant of team performance in the sport context (Curtner-
Smith, Wallace, & Wang, 1999; Pickens, 1994; Voight &
Callaghan, 2001). Some sport teams seem to perpetually
under-perform, while only a relative few appear to function
with the utmost efficiency and effectiveness. What
accounts for this disparity in team performance is typically
the subject of vigorous debate among media, fans,
coaches, and athletes (cf. Curtner-Smith et al., 1999;
Whannel, 2002). However, the respective accolades or
blame are frequently attributed to individual performance,
with little regard given to the group as a functional unit
(Whannel, 2002). Aside from traditional mainstream,
overt factors such as variance in coaching ability, player
talent, and critical in-game decisions, researchers have
shown that group cohesion, which is often less perceptible,
may also impact performance (Carron, Colman,
Wheeler, & Stevens, 2002; Heuzé, Sarrazin, Masiero,
Raimbault, & Thomas, 2006).
Carron, Brawley, and Widmeyer (1998) defined
cohesion as “a dynamic process that is reflected in the
tendency for a group to stick together and remain united
in the pursuit of its instrumental objectives and/or for
the satisfaction of member affective needs” (p. 213).
Widmeyer, Carron, and Brawley (1993) determined that
83% of the studies conducted in the area of cohesion
found a positive correlation between cohesion and group
performance. Therefore, understanding the relationship
between cohesion and performance and the factors that
either foster or inhibit cohesion would benefit sport
managers and/or coaches in pursuit of high performance.
For the past two decades, nearly all research conducted
in the area of team cohesion has used the conceptual
framework introduced by Carron, Widmeyer, and
Brawley (1985). To help define, categorize, and measure
levels of cohesion, the model developed by Carron et al.
divides cohesion into four dimensions: group integrationtask
(GI-T), group integration-social (GI-S), individual
attractions to the group-task (ATG-T), and individual
attractions to the group-social (ATG-S). Cohesion
within this framework has been evaluated based on the
widely-used Group Environment Questionnaire (GEQ),
an 18-item self-report inventory anchored on a 9-point
Likert-type scale. While this framework is extensively
used within the sport psychology literature, few have
explored alternative tools that may provide new insight
and more illustrative ways to evaluate team dynamics.
Within the more general management literature, a body
of research known as social network analysis (SNA)
provides potentially revelatory metrics for the measurement
of the individual relationships that comprise the
social entities to which people belong. In fact, Quatman
and Chelladurai (2008) characterized SNA as “a new
and promising research lens to the field of sport management”
(p. 339).
54 Warner, Bowers, and Dixon
In response to these potential new insights, this study
utilizes SNA as a tool to explore the structural cohesion
of two collegiate basketball teams. SNA provides insight
into the structure of a team, specifically the dyadic
relationships. In the sport psychology literature, team
cohesion has been conceptualized as a property of teams,
one that emerges from the interactions of team members,
but one that coalesces into a holistic group property that
cannot be reduced to its lower level elements (e.g., Carron
et al., 1985; Carron et al., 1998). This type of cohesion
might be similar to the atoms that make up the structure
of a molecule, where the atoms coalesce into a single unit
and the molecule is the only meaningful level of interest
(see Dansereau, Alluto, & Yammario, 1984). Similarly,
individuals could coalesce into a team, and the actions and
performance of the team as a whole becomes the unit of
analysis. This approach to cohesion helps us understand
groups as a holistic unit and the outcomes related to
group-level functioning.
SNA, by contrast, examines cohesion at both the
individual and the group level and is interested in process
and structure, individuals and the group, and also the various
relationships within the group. Structural cohesion—
the term used in the SNA literature to reflect the density
of a network—examines the emergent compilation of
relationships between network members in both part
and whole. In the words of Kozlowski and Klein (2000):
This type of perspective attempts to understand how
the dynamics and interactions of lower-level elements unfold over time to yield structure or collective
phenomena at higher levels. This perspective is not
a reversion to reductionism; rather, it is an effort to
comprehend the full complexity of a system—its
elements, their dynamics over time, and the means
by which element in dynamic interaction create collective
phenomena. (p. 16)
Thus, both perspectives—emergent as whole, and
emergent as part and whole—are compatible, but different.
In fact, it is possible that the kind of structural
cohesion studied with an SNA approach could be an
antecedent to “team cohesion” as a holistic property and
could provide insight into the dynamics behind such
shared unit-level behavior.
Through the use of a roster-based adjacency matrix
survey, SNA differs from the GEQ and most other instruments in that it is tailored to each individual group or team.
As Wasserman and Faust (1994) noted, “From the view
of social network analysis, the social environment can be
expressed as patterns or regularities in relationships among
interacting units” (p. 3). In addition to these relational
concepts, the authors also identified four unique characteristics
of SNA that substantiate how this tool provides a
departure from other empirical tools. First, SNA assumes
that actors and their actions are interdependent rather
than independent, autonomous units. Second, relational
ties between actors are assumed to be channels through
which both tangible and intangible resources may flow or
be transferred. Third, network models view the structural
environment of the network as having the potential to either
constrain or enable individual agency. Fourth, network
models conceptualize the structure of the network as the
expression of lasting patterns of individual relationships.
Wasserman and Faust also asserted that a social network
analyst would “seek to model these relationships to depict
the structure of a group. One could then study the impact
of this structure on the functioning of the group and/or the
influence of this structure on individuals within the group”
(p. 9). Therefore, SNA measures can provide a useful tool
to better understand team dynamics, individual roles within
the group, and network evolution while concomitantly
elucidating issues related to organizational cohesion,
effectiveness, and performance. As a result, this study uses
a case to introduce and demonstrate the viability of SNA
for examining team dynamics and structural cohesion.
Quite simply, “The man who correctly understands
how a particular structure works can prevent it from working
or make it work differently with much less effort than
a man who does not know these things” (Bailey, 2001, p.
187). In the case of athletic teams, equipping a coach with
knowledge of a team’s oft-imperceptible relationships
and structures should yield similar benefits. That is, a
coach with knowledge of the intricacies and key relational
structures within his or her team can more effectively
lead the team to success. Utilizing a longitudinal SNA
design, this case study not only depicts the various social
networks within the teams, but also begins to address a
number of underdeveloped theoretical areas including:
(a) the evolution of social networks over the course of a
season, (b) the role that specific individuals play within
the networks, and (c) the relationship of various networks
with team performance. While a discussion of the case
context and specific results are warranted to fully appreciate
SNA, it must be understood that the focus of this
study is on SNA and its application, not necessarily on
the intricacies and in-depth analysis of the case itself.
Review of Literature
Team Performance
The relationship between team performance and cohesion
seems an obvious one. As levels of cohesion rise,
so should team performance. The same is true for the
corollary: as team performance improves, the levels of
cohesion should continue to increase. In fact, Martens
and Peterson (1971) illustrated this circular relationship
in one of the first empirical studies ever conducted in
the area of team cohesion. The research focused on a
large sample of intramural athletes and measured the
effect that team cohesiveness had on individual player
satisfaction levels and overall team performance. The
results indicated a strong relationship between levels of
team cohesiveness and team performance, implying that
teams with higher levels of perceived cohesion are more
likely to succeed, and more successful teams are in turn
Team Dynamics: A Social Network Perspective 55
more cohesive. Numerous studies have since supported
this connection across many different types of sports (for
recent examples, see Heuzé, Raimbault, & Fontayne,
2006; and Magyar, Feltz, & Simpson, 2004).
Despite corroborating this same relationship, Carron
et al. (2002) alluded to the lack of explanatory insight found
in the literature. Ostensibly, what the authors referred to
was that although the relationship between cohesion and
performance has been established, an examination of
mediating (explanatory) variables is necessary to better
understand the cohesion-performance relationship. Heuzé,
Raimbault, and Fontayne (2006) noted that the relationship
between performance and cohesion necessitates an
examination of potential mediators, while understanding
the conditions that give rise to the performance-cohesion
relationship requires an exploration of potential moderators.
Although, to this point, the literature has failed to
adequately address which mediators and moderators have
the most significant impact, there exists strong evidence
that collective efficacy can often be an important mediator
of the relationship between cohesion and performance.
Logically, “players in more cohesive teams may hold
stronger shared beliefs in their team’s competence, which
in turn may lead to greater team success. And group performance
success may increase players’ perceptions of
collective efficacy, which in turn may contribute to the
development of cohesion” (Heuzé et al., 2006, p. 61). Some
research indicates, however, that this triadic relationship
can often be more complicated and confounding than the
linear relationship these scholars described.
Social Network Analysis
Deriving many of its principles from graph theory, SNA
utilizes algorithms and procedures that allow a researcher
to map social structures that otherwise may be unnoticed.
As Wasserman and Faust (1994) explained, SNA provides
the analytic tools to “translate core concepts in social and
behavioral theories into formal definitions expressed in
relational terms” (p. 20). SNA, therefore, can complement
and enhance our understanding of multifaceted relationships
such as cohesion by aiming to better understand
the relational embeddedness and connectedness of social
units at the individual, organizational, and/or structural
level (Kilduff & Tsai, 2007). In fact, Burt (1980) noted
this potential for connecting micro- and macro-level
structures as one of the primary benefits of SNA. In this
regard, SNA provides a unique empirical tool through
which to examine and expand the theoretical contributions
of earlier research aimed at understanding team dynamics
and structural cohesion. That is, understanding the social
structures of a group would lend explanatory power to the
perceptions of team dynamics and structural cohesion.
Whereas nonnetwork measurements such as Carron et
al.’s (1985) GEQ are unable to test theoretical propositions
related to structural properties, SNA provides “a collection
of descriptive procedures to determine how the system
behaves, and statistical methods to test the appropriateness
of the proposition” (Wasserman & Faust, 1994, p. 22).
By collecting whole social network data, the centrality
of each actor in the network can be determined
using a variety of measures, the simplest of which
include in-degree (i.e., popularity of an individual),
betweenness (i.e., connections to unconnected individuals),
and eigenvector (i.e., connections to individuals
who are central; Kilduff & Tsai, 2007). In addition,
structural cohesion, or the overall connectedness of
network, is also frequently analyzed. Toward that end,
this study employs SNA as a tool to explore the structural
cohesiveness of two women’s collegiate basketball
teams over a season.
Method
This study applied established social network cohesion
methodologies to a sport-specific case study. In the current study, the researchers measured the levels of cohesion
in four specific areas, three of which come directly from
the SNA literature (Krackhardt & Hanson, 1996). These
three preestablished measures uncovered and explicated
the friendship (i.e., I consider this a person a friend),
trust (i.e., I trust this person), and advice (i.e., I went to
this person for advice) networks of each participant. To
build upon and contribute to the traditional literature in
this area, we also included a more sport-specific measure
of individual (and ultimately collective) efficacy (Spink,
1990). That is, an efficacy criterion (“I felt confident about
this person’s basketball-related knowledge and/or ability”)
was also included. Combined, these four measures
provided insight that extends the depth and scope of
current work within the area of cohesion. Although the
four constructs are analogous with factors derived from
previous research, it is important to differentiate that
Carron et al.’s GEQ, for example, is a self-report inventory anchored on a 9-point Likert-type scale that measures
an individual’s perceptions of the group’s integration
and the individual’s attraction to the group. In contrast,
SNA is a tool in which measures are based on explicitly
defined relationships between the individual actors.
Therefore, although the measures used in the current
study reflect an understanding (consistent with previous
research) which suggests that cohesion is comprised of
both social (in this case, friendship and advice networks,
which represent expressive and instrumental social ties,
respectively) and task-related (in this case, trust and
efficacy networks) components, the actual measures have
been reframed to afford an analysis in concert with the
SNA literature (cf. McPherson, Smith-Lovin, & Cook,
2001; Mullen & Copper, 1994). (Note: while trust has
been defined in numerous ways, recent literature points to
trust being a key component of effectiveness, leadership,
and performance [e.g., Dirks, 2000; Dirks & Skarlicki,
2009; Dixon & Roach, 2006]. Based on this interpretation,
trust was categorized as being task-related.) SNA
focuses on the amalgamation of specifically defined
dyadic relationships to provide insight into team and
group structure and process.
56 Warner, Bowers, and Dixon
Participants
The participants included members of two NCAA Division-I women’s basketball teams who gave their informed
consent to take part in the study. Participants received a
letter notifying them of the study and making them aware
that participation was voluntary and had been approved
by institutional human subjects review. Twenty-seven
members of Team A (one head coach, three assistant
coaches, nine support staff, and 14 players comprised
of five starters and nine reserves) and twenty members
of Team B (one head coach, two assistant coaches, three
support staff, and 14 players comprised of six starters
and eight reserves) completed the study. Starters versus
reserves were determined based on the end of the year
game statistics. Players who started a majority of the
games and played the most minutes were classified as
“starters.” The participants ranged in age from 18 to 45,
with the majority being between 18–22 years old. Most
of the participants (n = 43) were female, but a few of the
coaches and support staff were male (n = 4).
All members of the teams were asked to participate,
including the players, coaches, and support staff (i.e.,
nonplayers and noncoaches associated with the day-today
operations of the team, such as directors of basketball
operations, administrative assistants, student managers,
and athletic trainers). Although the extant literature typically
restricts its analysis of cohesion to only the players
on a given team, the decision to include coaches and
support staff in the analysis was based on the idea that
the functioning of a team depends on the synthesis of all
its parts—not just the players.
Due to the nature of SNA research, one group of
individuals, or in this case one team, would be considered
a sufficient sample to conduct an SNA inquiry
(Kilduff & Tsai, 2007). However, the additional team
allowed for the researchers to compare and contrast the
two teams (networks) over the course of a full season.
Basketball teams were chosen for analysis due to the
nature of the sport being one in which individuals are
highly interactively dependent on one another (Carron
& Chelladurai, 1981).
The make-up of the two teams was also considered in
the research design. Both teams competed in comparable
athletic conferences (i.e., “Mid-major” Division-I conferences)
and therefore chose to attend somewhat similar
colleges. In terms of social status and background the
differences between the teams were negligible; however,
comparatively, the teams were somewhat demographically
distinguishable with regard to the socioeconomic
background of the players. That is, the Team A players
mostly hailed from suburban middle class geographic
areas, while the Team B players tended to be from rural
areas characterized by populations with lower socioeconomic classes. During the season in which the teams were
surveyed the two teams also diverged in terms on their
on-the-court success. Notably, Team A posted a winning
season (.56 winning percentage), tripling their number of
wins from the previous year, and recording the school’s
first postseason victory in over 15 years. Team B, on
the other hand, recorded arguably one the school’s least
successful seasons in 20 years as the team struggled to
win even 25% of its games.
Procedure
The two teams completed a short online survey at four
critical points during the basketball calendar year. These
critical points were based on feedback from both current
and former coaches. Those points in time included the offseason
(early August), preseason (October/November),
following nonconference play or midseason (December/
January), and end of season (March). On the roster-based
survey, the participants indicated which team members fit
a given criteria and provided information related to each
of their social networks to track any possible network
changes as the season progressed. The criteria employed
to generate the four networks were concise, which is
consistent with standard network methodology: I went
to this person for advice; I trust this person; I considered
this person a close friend (regularly got together outside
of team functions); I felt confident about this person’s
basketball-related knowledge and/or ability. Participant
responses to these indices were then imported and formatted,
as square adjacency matrices comprised of the
aggregated responses of each individual regarding his
or her teammates.
Data Analysis
After the data were complied, social network analysisspecific
software called UCINET (Borgatti, Everett, &
Freeman, 1999) was used to generate indices of cohesion
for the advice, trust, friendship, and collective efficacy
networks. In this study, structural cohesion was measured
using the “density” calculation within the software, which
determines the proportion of the number of connections or
ties that exist between actors in relation to the number of
the maximum possible connections or ties in the network
(Kilduff & Tsai, 2007). For example, if all individuals in
the network were “isolates” or unconnected, the structural
cohesion measure would be zero (.0000); whereas if all
actors were connected to one another the structural cohesion
for the network would be one (1.000). Specifically,
the data were compared with team performance (i.e.,
winning percentage) to determine if any patterns between
these constructs emerged. In accordance with standard
SNA practice, visual inspections of the generated networks
were also included to assess the data (Kilduff &
Tsai, 2007). Although there is not a particular criterion for
analysis in the inspection process, conclusions are drawn
through cross-referencing the graphical output with both
the generated indices and the researcher’s intuition (Wasserman
& Faust, 1994).
Team Dynamics: A Social Network Perspective 57
Generated Hypotheses
The following section presents the SNA results for each
of the teams in this case study. While the data are introduced
in detail to explain the meaning and utility of the
different measures, the ultimate goal of this research is to
generate hypotheses that could be tested using inferential
methods (e.g., teams with a high level of structural cohesion
in their efficacy networks will have a higher winning
percentage compared with teams with a low level of structural cohesion in their efficacy networks). Examples of the
kind of hypotheses that could be generated are presented
at the end of this section and throughout the discussion.
Table 1 depicts how the two team networks evolved
over the course of a season by highlighting the changes
in overall structural cohesion of the different networks
and the four critical points in the season. For purposes of
demonstration, Tables 2 and 3 provide the individual indegree
centralities (i.e., the number of incoming ties) that
comprise the overall structural cohesion scores of each
team in the efficacy networks. Combined, these tables
illustrate the unique composition of an SNA perspective
relative to other measures that are traditionally employed.
As each of these tables confirms, only slight fluctuations
over the course of the season are observed. The only distinct
patterns to have emerged were the steady increase
of structural cohesion in Team A’s efficacy, trust, and
advice networks as the season progressed (see Table 1).
Figures 1, 2, 3, and 4 all graphically represent the
off-season and postseason social networking maps of the
two teams. A line between two actors indicates a relationship
exists and the arrowhead represents the direction
of the relationship. If a relationship were reciprocated
the line would have an arrowhead on both ends (e.g.,
the reciprocal tie between two bench players (B2 and
B3) in the Off-Season network depicted in Figure 3).
An example of a unidirectional tie can be seen in the
Off-Season network of Figure 1, where a line exists
between HC to S5 with an arrowhead pointed at S5. This
indicates that for the efficacy criteria (I felt confident
about this person’s basketball-related knowledge and/
or ability) the head coach (HC) affirmed this feeling
about the particular starter (S5). However, this relationship
was not reciprocated by S5 because an arrow is not
going from S5 with the arrowhead pointed at HC. Again,
the number of incoming ties (i.e., in-degree centrality)
is typically the most telling social networking measure
when evaluating the cohesiveness of a network (Balkundi
& Harrison, 2006).
Figures 1, 2, 3, and 4 also visually depict the changes
that occurred at the individual actor-level over the course
of a season. For example, Figures 1 and 2 highlight the
efficacy of the teams. In the efficacy networks for both
teams, the head coach (represented by the yellow triangle)
moves from a central location during the off-season to a
decentralized location at the end of the season. Another
change that emerges pertains to the starting players (see
Figure 3). Comparing the off-season to postseason, Figure
3 demonstrates how the starters formed somewhat of a
clique (i.e., a group that interacts with one another, but
has few common links to others) represented on the lefthand
side of the postseason graph.
With regard to team performance, a comparison of
the overall team structural cohesion measures in Table 1
demonstrates how one might begin to generate hypotheses
about the cohesion-performance relationship. The
Table 1 Longitudinal Cohesion Measures of Efficacy, Trust, Friendship, and Advice Networks
Team Off-Season Pre-Season Mid-Season Post-Season
Efficacy Efficacy Efficacy Efficacy Mean Efficacy
Team A 0.4569 0.4719 0.5272 0.6062 0.5156
Team B 0.2881 0.2719 0.3125 0.2596 .2955
Trust Trust Trust Trust Mean Trust
Team A 0.4554 0.4349 0.5449 0.5440 0.4948
Team B 0.313 0.269 0.3092 0.3614 0.3131
Friendship Friendship Friendship Friendship Mean Friendship
Team A 0.1892 0.1820 0.1651 0.2179 0.1886
Team B 0.1717 0.2573 0.2368 0.2632 0.2492
Advice Advice Advice Advice Mean Advice
Team A 0.1677 0.1716 0.1779 0.2509 0.1920
Team B 0.1524 0.1725 0.3059 0.2351 0.2355
58
Figure 1 — Example of Efficacy Network, Off-Season and Post-Season (Team A)
59
Figure 2 — Example of Efficacy Network, Off-Season and Post-Season (Team B)
60 Warner, Bowers, and Dixon
Figure 3 — Example of Friendship Network, Off-Season and Post-Season (Team A)
data indicate that the better performing team, Team A,
reported the highest levels of structural cohesion on the
efficacy and trust networks. Team A started the season
with a 0.4569 structural cohesion measure on the efficacy
network and ended the season at 0.6062; Team B, the less
successful team, started at 0.2881 and ended at 0.2596 on
this same network measure. This phenomenon can also
be observed through comparing Figures 1 and 2. These
figures show that Team A has a much denser (i.e., more
cohesive structure, as indicated by more connections)
network than Team B. A similar pattern emerged within
the trust network. Team A started the season at 0.4554 on
this network, and ended the season with a slightly higher
cohesion measure of 0.5440. Team B, on the other hand,
started with a 0.3130 structural cohesion measure on the
trust network and ended the season at 0.3614.
A different pattern, however, was observed within
the Friendship and Advice networks. In both of these
networks the mean structural cohesion measures over
the course of the season were higher for Team B, the less
successful team. For the friendship network, Team B had
a 0.2492 mean structural cohesion measure while Team A
was only at 0.1886. On the advice network the measures
were 0.2355 and 0.1920, respectively.
These observations, in combination with the existing
literature, help form the basis for the hypotheses that
a positive relationship likely exists between structural
cohesion on the efficacy and trust networks and team
61
Figure 4 — Example of Friendship Network, Off-Season and Post-Season (Team B)
62 Warner, Bowers, and Dixon
performance, while a negative relationship would likely
be found between structural cohesion on the friendship
and advice networks and team performance. That is,
these two cases suggest that increases in team cohesion
based on efficacy and trust should improve team performance,
while increases in cohesion based on friendship
and advice would negatively impact team performance.
Future research with a larger sample, however, is necessary
to confirm this supposition. For example, a simple
linear regression model would need to be constructed to
determine if structural cohesion scores could predict performance.
The structural cohesion scores of the efficacy,
trust, friendship, and advice networks on a large sample
of teams would serve as independent variables to predict
winning percentage over time.
Discussion
In considering the impact of these findings both in terms
of a case study demonstrating SNA methodologies and
a contribution to the existing work on team dynamics,
a number of compelling implications may be gleaned.
One of the most salient findings is the evidence of how
a network evolves and changes over time; in this case,
over the course of a basketball season. Another contribution
of this work to the study of team cohesion comes
from the potential for SNA approaches to generate a
multitude of examinations and hypotheses from the
same data set through the combination of individual
scores, group measures, and graphical depictions of
the network. Utilizing SNA allows for the possibility
of extensive individual- and group-level measures that
statistically corroborate and elaborate the visual representation
of the networks (e.g., in-degree centrality
and overall group structural cohesion). By visually and
quantitatively comparing the networks at different stages
of the season, meaningful changes in the networks can
be detected. This approach offers the potential for new
theoretical and practical insights into the formation and
structure of team networks.
Therefore, measuring structural cohesion with SNA
allows a researcher to visually depict a team network
in a manner that not only shows the overall structural
cohesiveness of a team or network, but also demonstrates
each individual actor’s role, position, and centrality
within a network. This method is useful in that it allows
researchers to deconstruct the team network down to the
individual level (cf. Kozlowski & Klein, 2000). From a
practical standpoint, this data are incisive in that it can
uncover network structures that are not typically observable
to a coach or manager, while doing so in a manner
that is heuristically simple for a practitioner who may
have little theoretical knowledge of team cohesion measures.
Consequently, this knowledge could then strategically
be used to assist a coach or manager in identifying
the potential opportunities and obstacles to creating a
more structurally cohesive team. For example, if a team’s
network map (i.e., visual map of the aggregated dyadic
ties; see Figures 1–4 for examples) indicates that a player
is on the outer perimeter of the team’s trust network, a
coach could use this information as a diagnostic tool
to identify and mitigate potential interpersonal conflict
through the use of his or her managerial acumen and
leadership training.
This study builds upon Carron et al.’s (1985)
work in that while it can be used to further describe
and evaluate the team environment as a whole, it also
begins to answer the call in Carron et al.’s (2002) work
for a measurement tool that provides more nuanced
insights and explanatory potential. Carron et al.’s
(1985) Group Environment Questionnaire would likely
have also shown that Team A was the more cohesive
team. However, by using SNA, researchers are able to
generate an assessment of the team that is grounded in
explicitly defined actor-to-actor relationships rather than
a perception of the general environment. For example,
the importance of structural cohesiveness within the
efficacy and trust networks over time was demonstrated
within this study, further substantiating the potential
of these variables to mediate cohesion levels. Perhaps
even more telling were the simple visual depictions of
the relationships in the networks. Based on an analysis
of these graphs, a researcher can visually inspect the
dyadic relationships within team and the overall density
of the network at different points, and more importantly,
show which individual actors are central to the network
at different points of the season. Often the importance
of these key individuals in terms of serving as links in
the organizational chain is unobservable without the aid
of a tool like SNA.
SNA uncovers the patterns of interactions among
individuals in a network, and can reveal imperceptible
yet crucial connections. Knowledge of such connections
could potentially be used by leaders for the betterment
of the entire team. For example, most would assume
that starters (players that typically receive a majority
of the playing time) and head coaches would be central
within the efficacy network structures. However, as
Figure 1 (as well as Table 2) demonstrates, this was not
the case for Team A. Rather, bench players (players that
typically see little to no playing time) and support staff
were central in this network. This counterintuitive finding
reveals important testable hypotheses that go beyond the
traditional cohesion measures, and begin to elucidate the
mechanisms underlying the dynamics of this team. In this
particular case, an SNA approach allows researchers to
see not only that the team was structurally cohesive, but
also the key roles that bench players and the support staff
have in the network. Thus, these potentially overlooked
individuals who are often assumed to be ancillary to the
operations of a team were the proverbial “glue” holding
the team together in this particular case. Without the
multifaceted approach afforded through the use of this
new analytic tool, this level of revelatory insight would
not be possible.
To give another example of how SNA could potentially
be used as a diagnostic tool for team cohesion,
this study specifically shows how both head coaches
Team Dynamics: A Social Network Perspective 63
held more central positions in all four of the networks
during the off-season only to move to more decentralized
positions at the end of the season. Leader Membership
Exchange Theory, which espouses the importance of
the quality of relationship and connections between
an individual and supervisor, could further explain the
significance of this movement. Thus, another potential
hypothesis for exploration is that a coach who maintains
a more central position within a network structure
may indicate a higher quality of Leader Membership
Exchange relationships within the team. This is important
because in Leader Member Exchange studies such
Table 2 Example of Longitudinal In-Degree Centrality for Efficacy Network (Team A)
+
Individual
Off-Season Pre-Season Mid-Season Post-Season
In-Degree In-Degree In-Degree In-Degree
S1 14 14 17 16
S2 11 12 14 14
S3 13 13 14 13
S4 16 14 16 18
S5 7 8 11 9
B1 4 6 3 8
B2 11 13 14 13
B3 5 9 10 9
B4 7 11 10 9
B5 19 20 21 20
B6 15 20 18 16
B7 14 19 18 18
B8 10 8 9 8
B9 6 6 6 3
HC 5 8 4 2
A1 8 10 9 11
A2 14 20 18 17
A3 10 8 9 11
U1 11 12 8 9
U2 13 11 12 12
U3 10 12 11 13
U4 13 12 16 17
U5 15 14 13 15
U6 15 12 16 14
U7 7 7 11 13
U8 13 11 11 13
U9 11 9 10 10
Mean 11 11.8 12.2 12.3
SD 3.8 4 4.4 4.3
Min. 4 6 3 2
Max. 19 20 21 20
+
S = Starter; B = Bench Player; HC = Head Coach; A = Assistant Coach; U = Support Staff
64 Warner, Bowers, and Dixon
relationships have been found to be associated with
higher levels of performance, commitment, satisfaction,
and retention (see Graen & Uhl-Bien, 1995; Schriesheim,
Castro, & Cogliser, 1999). Future research should continue
to explore the inclusion of external actors (i.e.,
coaches and support staff) within the measures employed
to assess cohesion, and should supplement the analyses
with qualitative explanations to better understand the
importance of their position within the network. With
a larger sample of teams, the individual head coaches’
cohesion centrality scores could also be inferentially
tested to determine the relationship that exists been
these scores and team performance. Again, a simple
linear regression model with head coaches’ individual
cohesion centrality scores serving as the independent
variable could be constructed to determine if team
performance could be predicted. As Dion (2000) notes,
understanding vertical cohesion in addition to the more
traditionally measured horizontal cohesion could provide
a more comprehensive assessment of a group’s overall
cohesion. For example, it is possible that a coach may
move to the periphery of the network not because of a
diminishment in the quality of his/her relationships, but
perhaps as a result of empowering players to take a more
prominent role in the direction of the team. Without a
more nuanced understanding, motivation and leadership
strategies may be overlooked.
SNA also demonstrated the emergence of a clique
among the starters in Team A (see Figure 3) within the
friendship network over the course of the season. From
this evidence, it may be hypothesized that the more time
interacting on the court help initiate bonds off the court,
or perhaps that the positive team performance yielded
friendship that did not exist before season.
Additional hypotheses could be generated around
the types of cohesion (task and social) and their unique
relationships to performance. Previous research has
indicated that task cohesion compared with social
cohesion is more strongly correlated with work performance
(Brawley, Carron, & Widmeyer, 1987; Carless
& De Paola, 2000; Mullen & Copper, 1994; Williams
& Widmeyer, 1991). Task cohesion can be defined as
the motivation or commitment toward common goals
(Widmeyer & Williams, 1991), while social cohesion is
focused more on interpersonal relationships with other
group members. To an extent, the current data support
this notion. That is, the structural cohesion measures in
the efficacy and trust networks, which could be thought
of as more task-oriented networks, were considerably
higher in Team A, the better performing team. In other
words, the previous findings that assert the importance
of task-oriented cohesion were corroborated within
these two teams. Team B, the less successful team,
however, recorded higher structural cohesion measures
for the more socially orientated networks, friendship
and advice (Table 3). This may be further support for
the notion that task cohesion is a more salient determinant
of future performance. It is also important to note
that the efficacy and trust networks were quite similar,
thus indicating these networks could be measuring the
same construct. Although these results provide slightly
more nuanced support for the existing theories that
identify task cohesion (instead of social cohesion) as
an antecedent for higher performance, the findings also
raise questions about the nature of social cohesion,
particularly in terms of its purported relationship as a
consequence of success. In this study, the higher performing
team (Team A) reported consistently low levels
of social (advice and friendship) cohesion; in fact,
the lower performing team (Team B) reported higher
levels of social cohesion than Team A. This suggests
that perhaps the relationship between performance and
social cohesion may be influenced by other factors.
Future research should continue to explore and test
these relationships.
Despite the fact that more socially-oriented networks,
such as friendship and advice, appeared to not
be as strongly related to performance, a coach or sport
manager should not dismiss the importance of socially
cohesive networks, especially for female athletes. Spink
(1995) concluded that social cohesiveness for females
was positively related to female athletes’ intentions to
continue participating in team sports. Similarly, White
(1993) discovered that, compared with their male counterparts,
female athletes were significantly more teamoriented
and placed a greater importance on the social
aspect of the team experience. Although the friendship
and advice networks did not appear to be strongly related
to team performance, future research should consider
the impact such networks would have on retention and
athlete satisfaction.
Conclusion
As research in team cohesion continues to evolve,
researchers can benefit from a multitude of perspectives
and tools. While the laudable contributions from Carron
and colleagues’ (1985) Group Environment Questionnaire
continue to provide a useful measurement for team
cohesion, the field must continue to advance through the
introduction of complementary tools such as those available within an SNA perspective. As with most team cohesion
research, socially desirable participant responses
may be a limitation. Future research would benefit from
synthesizing the relative contributions of the GEQ and
SNA, while supplementing these analyses with inferential
statistical analyses and qualitative research components.
Consequently, the purpose of conducting this exploratory
study was not to debunk the valuable advancements that
have been made within the realm of team cohesion, nor
was it necessarily to provide a complete treatment and
analysis of the two specific teams. Rather, the intention
of this article was to introduce sport managers and
practitioners to a new tool that is at their disposal in the
ongoing quest for generating richer explanatory and
predictive analyses.
Team Dynamics: A Social Network Perspective 65
Table 3 Example of Longitudinal Degree Centrality for Efficacy Network (Team B)
+
Individual
Off-Season Pre-Season Mid-Season Post-Season
In-Degree In-Degree In-Degree In-Degree
S1 8 7 9 6
S2 4 3 2 2
S3 5 3 4 3
S4 5 3 3 3
S5 4 2 3 1
S6 3 5 6 4
B1 2 4 3 4
B2 6 6 7 5
B3 2 1 0 1
B4 7 7 7 6
B5 8 5 1 2
B6 7 7 8 4
B7 6 6 8 6
B8 6 5 3 5
HC 6 9 7 7
A1 2 1 0 1
A2 7 5 7 4
U1 4 4 4 2
U2 7 7 7 4
U3 5 3 6 4
Mean 5.2 4.7 4.8 3.7
SD 1.9 2.1 2.7 1.8
Min. 2 1 0 1
Max. 8 9 9 7
+
S = Starter; B = Bench Player; HC = Head Coach; A = Assistant Coach; U = Support Staff
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2. Team Cohesion Defined
One definition of cohesion is “a group property with individual manifestations of feelings of belongingness or attraction to the group” (Lieberman et al., 1973: 337). It is generally accepted that group cohesion and performance are associated. “However, the issue of a cause/effect relationship between group cohesion and performance is not completely resolved. Generally, there tend to be more studies supporting a positive relationship between group cohesion and performance.” [1] With that in mind the following article is an effort to enhance group/team cohesion and as a result help improve group/team performance.
[edit] The Question
What is team cohesiveness and why does it matter to an organization to have cohesiveness within its teams?
[edit] Team Composition
[edit] How to promote team cohesion when selecting and identifying diversity within teams
In their journal article Beyond Relational Demography: Time and the Effects of Surface- and Deep-Level Diversity on Work Group Cohesion, David A. Harrison, Kenneth H. Price, and Myrtle P. Bell discuss the composition of teams and its effect on cohesiveness. They describe two different categories of diversity, namely surface level and deeper level.
[edit] Surface-Level Diversity:
Surface level attributes are “immutable [and] almost immediately observable.” [2] Such attributes include age, sex, and race/ethnicity. In general, the findings have been fairly inconsistent within and across studies as to how diversity in these areas affect team cohesion.
[edit] Deep-Level Diversity:
Deep-level diversity includes differences among members’ attitudes, beliefs, and values. These attributes are less apparent than surface-level differences and are “learned through extended, individualized interaction and information gathering.” [3] They are communicated differences which are shared through both verbal and nonverbal behavior. There has been less research done in this area with regards to teams in workplace settings, though a number of social psychological studies have been conducted. The findings consistently suggest that “attitudinal similarity [is] associated with higher group cohesiveness.” [4] Diversity also improves communication, reduces personal conflict, attracts friendships, and gives more satisfaction to group members.
[edit] Summary
Overall, the school of thought that is most widely accepted, in regards to team cohesion, is that “surface-level differences are less important and deep-level differences are more important for groups that had interacted more often” [5] . Harrison, Price, and Bell’s study concluded that while homogeneous groups interacted and performed more effectively than heterogeneous groups in the beginning, with time and information, the diverse groups’ performance and processes improved more rapidly and “had grown more effective in identifying problems and generating solutions” [6] . Overall cohesiveness was strengthened in such cases. Hence, for optimum results, teams ought to include deep-level diversity as part of the process for achieving cohesiveness.
[edit] Internal Environment Factors Needed in Team Cohesion
Internally there are several factors that must be present for cohesion to exist within a team. First good and appropriate communication is essential to creating and maintaining cohesion. Communication leads to the second factor, unity of purpose. For a team to work as a cohesive team they must share a common goal and to collectively work towards that goal. And finally, the team must have a high level of commitment understanding that what they do together as a team is better than what they do on their own.
[edit] Communication
In the article “Building Team Cohesion: Becoming “We” Instead of “Me” the authors stress the importance of not losing the “human moment” which they define as “not to lose the powerful impact of face-to-face, immediate interaction in real time and space.” Furthermore, the authors add the following:
“It is communication in the “human moment” that most powerfully creates team synergy – the energy that truly makes “the whole greater than the sum of its parts.” It is communication in the “human moment” that also most powerfully creates team cohesion – a strong sense of loyalty and commitment to the team vision as one’s own.”
“Providing communication opportunities in real time and space for forensics team members is necessary to build team cohesion. Whether a room or lounge where team members can congregate between classes and the end of the day, practice space for formal and informal coaching sessions, travel time in cars and vans, or social time to enjoy pizza and a movie, both quantity and quality of communication are necessary to build a cohesive team climate of openness and trust…According to Bormann(1990), highly cohesive groups interact in an open climate where individuals are free to ask questions and disagree with one another; even the ability to work through inevitable team conflict in such a constructive climate will only serve to strengthen team cohesion.”
In order to build cohesion within any team whether it be a sports team or work team communication is an essential ingredient. Providing opportunities for the team members to interact socially is necessary to help build trust. In addition, a safe environment in which the team can deal with conflict is critical to team cohesion.
[edit] Unity of Purpose or a Common Goal
A critical factor that must be present for groups or teams to experience cohesion is to have a common goal. In SELF-MANAGING WORK TEAMS:An Empirical Study of Group Cohesiveness in “Natural Work Groups” at a Harley-Davidson Motor Company Plant, the authors state: “that highly cohesive groups tend to perform better because they have high commitment to attaining group goals (e.g., Stogdill, 1972), and because the members are more sensitive to others in the group, they are more willing to assist each other (e.g., Schachter, Ellertson, McBride,&Gregory, 1951).”
Additional support to the importance of a common goal in building and maintaining a common goal is found in “Buliding Team Cohesion: Becoming “We” Instead of “Me” where the author relates the following:
“Since cohesion is believed to be one of the distinguishing characteristics of a high-performance team, what is this powerful team quality and how is it cre-ated? According to Bollen and Hoyle (1979), cohesion is the degree of attraction members feel toward one another and the team; "it is a feeling of deep loyalty, of esprit de corps, the degree to which each individual has made the team's goal his or her own, a sense of belonging, and a feeling of morale" (as cited in Beebe & Masterson, 2000, p. 122). Though cohesion is rooted in the feelings team mem-bers have for one another as well as a common goal, creating, shaping, and strengthening those feelings relies on the use of effective communication. Communication scholars have long agreed that group or team cohesion is as much about the relationships created as the task at hand, and success in both fos-ters the development of team cohesion. (Bormann, 1990).
Without a purpose or a common goal a team will eventually splinter into separate individuals working towards their own personal agendas and not together toward a team goal. It is important for team members to see themselves as a part of the group working towards a goal for cohesiveness to exist.
[edit] Commitment
Teams that are not committed to each other or a common goal do not experience cohesion and are much more like to leave the team or even the organization. In the article "Commitment and the Control of Organizational Behavior and Belief" the author states the following:
"Commitment also derives from the relation of an employee's job to those of other in the organization. Some jobs are rather isolated and can be done independently of other jobs in the organization. It has been found that jobs which are not integrated with the work activities of others tend to be associated with less favorable attitudes. (Sheperd, 1973). Gow, Clarkand dossett (1974), for instance find that telephone operators who quit tend to be those who are not integrated into the work group. Work integration can affect commitment by the fact that integrated jobs are likely to be associated with salient demands from others in the organization. If a person has a job which affects the work of others in the organization, it is likely that those other will communicate their expectations for performance of that job. Such expectations can be committing in that the other people implicitly or explicitly hold the person accountable for what he does. Earlier we mentioned that when individuals did not know what was expected of them they tended to be less committed to the organization. One reason an individual will not know what is expected is because no one is telling him. In general, we would expect that anything which contributes to creating definite expectations for a person's behavior would enhance his felt responsibility, and hence commitment."
We learn from the above author that for commitment to exist we employees need to know what is expected of them and then to know they will be held accountable either by a manager or other co-workers. Once commitment is present team members are more likely to stay and work towards the team goal.
[edit] Role of Management in Team Cohesion
The roles that management has in a team that they oversee are extremely important. But it is also important for the management to understand the boundaries of what their roles and responsibilities are and what the roles and responsibilities of the team itself are. The manager is often placed in the management position because of their people and technical skills and experience. A team often benefits from the manager’s abilities, skills, aptitudes, insights and ideas. But neither the management nor the team should ever forget that it is the team’s responsibility to perform the actual work. So what role should management play in a team that they oversee? How best can they serve the team to ensure they are successful? A critical role that management can and should have is to facilitate and encourage team cohesion.
[edit] Establish the Team Vision/Goal
The first step in creating team cohesion and where management should be involved is in the establishment of the team vision and/or goal. Management must set a clear vision to which the team can jointly work towards together. As Tommy Lasorda, former manager of the LA Dodgers, stated, “My responsibility is to get my 25 guys playing for the name on the front of their shirt and not the one on the back.” [7] Management must “establish a common goal for [the] team – an underlying target that will bind [them] together…” [8] The goal must be as clear as possible for each member of the team. “Goal clarity is critical for team members to have confidence in their direction and to be committed to make it happen.” [9] A clearly defined goal articulated to the team in such a way that they all understand will inspire the team and commit them to the cause.
Once the goal has been clearly defined and clearly articulated, management must keep the vision and goal alive. Obstacles, tension, and crises may arise that can distract or discourage away from the common goal. The management must “continually reinforce and renew the team goal.” [10]
Being that managements “primary responsibility is to ensure that the team reaches its goal,” [11] management must also facilitate a working environment, set clear expectations and responsibilities, and lastly, let the team do their job.
[edit] Facilitate a Working Environment
Once the team vision and goal has been established, the most important contribution management can make “is to ensure a climate that enables team members to speak up and address the real issues preventing the goal from being achieved.” [12] Such a climate includes creating an environment of trust, communication and openness with each other. As Frank Lafasto describes in his book, openness and supportiveness are “the ability to raise and resolve the real issues standing the way of a team accomplishing its goal. And to do so in a way that brings out the best thinking and attitude of everyone involved. It’s too hard for team members to contribute, much less explore the possibilities, when it is not safe for them to say what’s on their minds. They must be able to speak honestly. They must be able to deal openly with real obstacles, problems, and opportunities in a way that promotes listening, understanding of differing perspectives, and constructively working towards a solution.” [13] The environment and climate in which the team works and operates must be facilitated by the management to ensure that trust is established, collective collaboration is demanded, and openness is welcome.
[edit] Set Clear Expectations and Responsibilities
Management responsibility is also to set clear expectations and responsibilities of the team and individual team members. Patrick Lencioni describes in his book “The Five Dysfunctions of a Team” that a team where there is ambiguity about the direction and priorities fails to commit. Whereas when the expectations, direction and priorities are clear the team is more likely to commit to the cause and each other. [14] Management must establish clear expectations so there is no ambiguity or question of what is expected of the team, whether it is the timeline, product, requirements, etc.
Also, management must set clear responsibilities. “There are few behaviors that build confidence as well as personalized expression of belief in an individual. One of the most direct signals of such belief is trusting someone with important and meaningful responsibility.” [15] Clear and meaningful responsibility that allows the team members to stretch enhances their trust and confidence. And, as Jack Welch, the CEO of General Electric, put it, “giving people self-confidence is by far the most important thing I can do. Because then they will act.” [16]
[edit] Training and Staffing
According to Chansler, Swamidass, & Cammann to get a task completed, “a work team must have the resources to do the job. Specifically, the team needs trained, competent team members. Training is a planned effort by a firm to help employees learn job-related competencies (Noe, 1999). Training is used by companies to gain a competitive advantage over rivals in their respective industries. A company must provide adequate resources to an empowered team to staff and train its members adequately.” It is the responsibility of Management to provide such training. Chansler, Swamidass, & Cammann also suggest management should provide its workers with both “hard” and “soft” skills. “Hard-skills training helps them do their jobs properly so that the plant can produce a quality product cost-effectively. Soft-skills training, on the other hand, teaches the workers to get along better as part of a functioning team; this type of skills training improves interpersonal dynamics and relationships. To effectively and efficiently manufacture quality product, both types of training are needed.” [17] It is therefore the responsibility of management to make sure that group/ team members have the hard and soft skills to perform tasks and maintain cohesion.
[edit] Get Out of Their Way
And lastly, the manager’s role is to get out of the team’s way. Once the team knows what they are working towards, tasks have been clearly defined and delegated, expectations are clearly set and they have the means to build relationships of trust and have open communication, the manager needs to step back and let the team work. The last thing the team needs, not only to reach their goal, but also to build strong cohesion is, as Dr. Travis Bradberry described, a seagull manager; one that swoops in when problems arise “squawking and dumpling advice, only to take off and let others clean up the mess.” [18] Management needs to let the members in the team be smart and informed about key issues and facts related to their tasks and goal. Then management must trust team members by providing sufficient autonomy, which will in turn build confidence.
[edit] Summary
Ultimately, the goal and role of management should be to add value to the team’s effort. This can be done by defining a clear vision and goal, facilitate a working environment, set clear expectations and responsibilities, and provide the team enough autonomy where they can work and do their jobs with full commitment and confidence.
[edit] Examples of Team Cohesion: The Good
A good example of team Cohesion is that of the Harley Davidson Motor Company (HDMC) and its group structure. The well known turnaround of HDMC occurred in the 1980s when it changed from a “command-and-control” culture to that of self-managing work teams (SMWT). This change allowed assembly employees to make important decisions in their work teams [19] . With group work as the foundation of HDMC’s manufacturing cohesion among group members was essential.
At its Kansas City Plant HDMC natural work groups (NWG) were organized to make decisions (and build motorcycles). The plant’s employees are made up of local union members. “This partnership allows the shifting of the decision-making and financial responsibilities for the operation of the plant to the assembly floor employees” [20] .
The structure of the plant divides workers into NWGs. Each NWG is either assigned to one of four process operations groups (POG) (the Assembly POG, the Fabrication POG, the Paint POG, or a POG dedicated to future programs) or provides “computer, human resources, materials, and so forth, support for the operations NWGs (denoted as RG or Resource Groups). Each of the NWGs is represented by NWG-elected (on a rotating basis) members. The highest level of the circular organization is the lone plant leadership group (PLG), which is cochaired by the plant manager and two local union presidents” [21] .
Within this group structure HDMC provides for widespread access to information. “All financial and operations information is available to all team members, which allows them to monitor budgets and production quotas” [22] . This access to information facilitates open communication which in turn leads to greater team cohesion. Cohesion is also furthered by the autonomy of workers within the group. “Each NWG is empowered to make decisions with regard to any aspect of the assembly process as long as it does not cross over its boundary and impede another NWG” [23] . With freedom to make any necessary decisions and freedom from continuous managerial intervention NWGs are free to bend and move as needed in response to any given situation.
Interestingly in this structure there are no formal team leaders. “NWGs are collectively led by the members of the group. Traditional leadership duties such as scheduling, safety monitoring, budget balancing, and so forth, are rotated among the NWG members on a regular basis (usually monthly). The NWG controls its own budget, sick pay, overtime, and consumable production materials. Individual performance measures are not maintained. The NWG performance is measured on achievement of plant goals and on the goals that they set for themselves” [24] . This sharing of responsibilities fosters cohesion by aligning the goals of the group, goals each member is included in creating.
[edit] Examples of Team Cohesion: The Bad
The 2010 film “The Social Network” is based on the events and circumstances that lead to the creation and founding of the social networking website “Facebook.” Founder Mark Zuckerberg and his friend, co-founder Eduardo Saverin agree to launch the site and split up ownership of the new company equitably. In the process of developing the company, other individuals and interests come into play that are detrimental to the team cohesion developed by Mark and Eduardo eventually leading to multi-million dollar lawsuits and the end of the original founding team.
Several factors that lead to the failure of team cohesion:
· Team members were unable to work together cooperatively
· Team goals were not shared by everyone on the team
· Team members felt that they were not recognized for individual contributions to accomplish team goals
· Selfish interests were able to infiltrate the team cohesion
The fact that team members were unable to work cooperatively together is likely the single biggest factor in the failure of the original “Facebook” leadership team. In the movie, to help advance the growth of the company, Mark brought in a third partner, Sean Parker, the co-founder of the famous music sharing sight “Napster.” Mark was instantly drawn to Sean’s charismatic personality and vision for “Facebook.” At the same time, Eduardo was highly skeptical of Sean and his business history. Immediately Mark began to lean toward the ideas that Sean had developed for “Facebook” and eventually gave Sean a small ownership stake in the company as well as a management position. Upon learning this, Eduardo was very upset that Mark would go ahead and make the decision to include Sean without consulting him first.
Mark and Eduardo both had visions of keeping this site exclusive for the elite college institutions around the country and gradually introducing it to other colleges. When Sean was brought into the company he presented Mark with a business plan to expand “Facebook” beyond the college scene and introduce it to the general public. At the same time he was trying to convince Mark that he needed to relocate the business to Palo Alto, CA from Boston, MA. Eduardo was never consulted on these propositions that were made to Mark. Eduardo felt like Sean was trying to push him out of the company and influence many of the decisions made by Mark. As the company grew and others were able to influence decision making, the team goals had clearly changed and not everyone shared the same vision.
When “Facebook” was originally started Eduardo was designated as the CFO of the company. In this responsibility he put up the initial seed money to get it off the ground. He was in charge of all finances and bank accounts for the company. While Mark was moving the company headquarters to Palo Alto, Eduardo was spending time in New York working on securing advertising contracts with prominent advertising firms. When Eduardo goes to visit the team in Palo Alto he begins to tell Mark all about the progress he has made with the advertisers but instead he is told all about the work that Sean and Mark had accomplished and is essentially told that his time and work in New York will not be needed. Eduardo felt like his contributions to the company and goals were not being recognized. This drives Eduardo further and further from the team.
Throughout the life of the original leadership team there were many occasions where selfish interests were able to infiltrate team cohesion. Sean was the worst offender of this. Sean was one of the founders of “Napster.” “Napster” was eventually forced to shut down and was facing many lawsuits from the record industry. Sean saw an opportunity to work with Mark and Eduardo on “Facebook.” Sean could see the potential that this venture had and also that he could influence the socially introverted Mark by filling him with visions of big pay days and a life style full of privilege. At times he appeared to try and relive his days of “Napster” and treated “Facebook” like it was his own company and he was trying to accomplish the goals there that weren’t achievable at “Napster.” After a party to celebrate the 1 millionth member of “Facebook,” Sean was arrested with several other “Facebook” interns for possession of cocaine and was eventually dismissed from the company. Through these actions, Sean clearly was acting in his own self interest and did not take into account what the effects would be on the group or company. In many ways the selfish actions of Sean drove a wedge between Mark and Eduardo that eventually lead to lawsuits and the end of the original leadership team. [25]
[edit] Conclusion
[edit] Ways to Increase Team Cohesion
Each group environment is different and will present different challenges. In order to create a cohesive team unit it is important for team members to be aware of this and work towards it. In Joseph Powell Stokes’s research, he found that “risk taking that occurs in a group, attraction to individual members of the group, and the instrumental value of a group are all related to the cohesion of the group”. He proposes that “increasing risk taking, intermember attraction, and the instrumental value of a personal change group might lead to increased cohesion, which in turn might lead to increase benefits for group participants.” [26]
As such, groups should attempt to foster an “atmosphere of tolerance and acceptance” so they can assure openness and honesty and hence, increase their risk taking and intermember attraction. They can “[reward] members who make risky self-disclosures or give honest feedback to other group members”. They should make sure group members know that they are expected to “like each other” and can help members “differentiate between not liking other members’ behaviors and not liking the other members themselves”. Group leaders ought to act as examples and make sure that the group composition and expectations of the group members are in line with risk-taking and intermember attraction. “Leaders can maximize the instrumental value of a group for its members by having the group focus explicitly on its goals and by helping redirect the group when members’ needs are not being met”. [27]
[edit] Potential problems
One possible caveat of cohesion is that when there is too much cohesion, groups are prone to groupthink. “Groupthink is a tendency by groups to engage in a concurrence seeking manner. Groupthink occurs when group members give priority to sustaining concordance and internal harmony above critical examination of the issues under consideration”. [28] It is important for all group members to be conscious of this pitfall and to take precautions to prevent such behavior. See Ways to Prevent Groupthink.
[edit] Referenes
^ Chansler, P. A., Swamidass, P. M., & Cammann, C. (2003). Self-Managing Work Teams : An Empirical Study of Group Cohesiveness in Natural Work Groups at a Harley-Davidson Motor Company Plant. Retrieved November 25, 2010, from Sage Journals Online: http://sgr.sagepub.com/content/34/1/101
^ Harrison, David A.; Price, Kenneth H.; Bell, Myrtle P. “Beyond Relational Demography: Time and the Effects of Surface- and Deep-Level Diversity on Work Group Cohesion”, The Academy of Management Journal, Vol. 41, No. 1 (Feb., 1998), pp. 96-107
^ Milliken, F. J., & Martins, L. L. 1996. Searching for common threads: Understanding the multiple effects of diversity in organizational groups. Academy of Management Review, 21: 402-433
^ Terborg, J. R., Castore, C., & DeNinno, J. A. 1976. A longitudinal field investigation of the impact of group composition on group performance and cohesion. Journal of Personality and Social Psychology, 34: 782-790.
^ Friedley, Sheryl A. and Bruce B. Manchester. 2005. Building Team Cohesion: Becoming “We” Instead of “Me”. George Mason University.
^ SELF-MANAGING WORK TEAMS:An Empirical Study of Group Cohesiveness in “Natural Work Groups” at a Harley-Davidson Motor Company Plant.SMALL GROUP RESEARCH, Vol. 34 No. 1, February 2003 101-120
^ Salancik, Gerald R. Organizational Socialization and Commitment: Commitment and the Control of Organizational Behavior and Belief. pp. 284-290
^ LaFasto, F., & Larson, C. (2001). When Teams Work Best. Thousand Oaks: Sage Publications
^ Lencioni, P. (2002). The Five Dysfunctions of a Team. San Franscisco: Jossey-Bass.
^ Bradberry, T. (2008). Squaqk. New York: HarperCollins Publishers.
^ The Social Network. (2010, 11 21). Retrieved 11 21, 2010, from Wikipedia: http://en.wikipedia.org/wiki/The_Social_Network
^ Stokes, Joseph Powell. Components of Group Cohesion : Intermember Attraction,Instrumental Value, and Risk Taking. Small Group Research 1983 14: 163
^ Managing Groups and Teams/Groupthink. (2010, March 23). Retrieved 11 15, 2010, from Wikibooks: http://en.wikibooks.org/wiki/Managing_Groups_and_Teams/Groupthink
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You are here: Home » Management » What Is Team Cohesion?
Team cohesion goes hand in hand with team bonding. In fact, team cohesion is what keeps any group or team together after the team bonding exercise is over. In this regard then, team cohesion is about maintaining the team bonding effect and preventing group fragmentation.
Any good team bonding activities should include common goals and purpose to ensure that team cohesion is in place in the future; if there is a common goal, there will be team cohesion. This is evident in extreme cases such as war, with a common enemy people team together and the cohesion is strengthened by the common goal. At a less extreme level, team cohesion is evident in a well run restaurant. The chef will communicate well with the maitre de, who will then communication with the wait staff. If the communication cycle breaks down then team cohesion is lost.
The restaurant comparison is actually a great team bonding activity. Managers can set up a scenario where the effects of good communication can be witnessed and team cohesion can be pinpointed to the moments it breaks down. Group charity drives are also excellent team bonding activities; remember that team cohesion begins after team bonding has taken place.
No matter how well the team bonding and team cohesion is established it must be constantly supported by management; this is especially true of middle management. Even with a common staff goal, if management seems to be disconnected or preferential then the team bonding holds no power and thus team cohesion suffers. It is vital then that in any team bonding exercises or team bonding activities management is seen to take part and to be an actual link in the cohesion chain.
Another situation where team cohesion can breakdown is where individual employees are singled out for praise. This is an essential element for the success of the employee; however, management must always include team praise as well. This collective praise brings the team together in a good way, so team bonding strengthens, and we have team cohesion. This moment is fragile and management must always be vigilant to strengthen the team bonding until it can stand alone.
Often, staffing is seen as burden in terms of cost and in terms of management however, without staff business would not survive. It is therefore vital that team bonding exercises are regular events and that post team bonding activities support is in place; this is the strengthening of team cohesion.
http://www.articleoutlook.com/what-is-team-cohesion/ Author Archives: The Writing Team
4. How to build cohesiveness in a team
by Amon Karagara
Created on: April 16, 2009
A team is said to be cohesive if its members can work together and unite in achieving its goals and objectives. It is easy to build a team. What is usually difficult is ensuring that members remain united in performing their duties. Yet this is the most crucial part of any team. Productivity and team cohesiveness are positively related i.e. a less cohesive team means less production, and vice versa.
It is therefore the duty of the team leader to create and maintain cohesiveness in a team. What keeps a team together may not be the same across all groups and organizations. However, by doing the following, most team leaders will begin realizing better results in their team's cohesiveness:
1. Identify and define the goals of the team and ensure that members focus on fulfilling them without looking at their interpersonal issues. A team that does not have clearly defined goals usually tends to stray away from work-related issues, into personal ones. When teams think about achieving the ultimate goal, they attach more importance to their work and hence remain more united for that purpose.
2. Encourage some form of competition amongst teams. If you have large groups of people, you can subdivide them into different teams and have each one of them compete with each other towards a certain goal. Or, if you have outside competition, inform them that their success is important towards to the organization's strength in the competitive world.
3. Be fair across the board. Do not show favoritism to one group or person over the other. This will create further division when the other party feels marginalized. So, when dealing with issues, make sure that you treat everyone the same.
4. Create avenues for interaction, such as office parties, weekend/after work get-together or any other non-work related function that brings your team together. This will encourage them to mix and laugh and get to acquaint themselves with each other. When they return to work, they will see each other as friends and end up working as one team.
5. Encourage face-to-face and open communication. Do not let members backbite and gossip about each other. Instead, let members interact in person, even when solving issues. If there is some kind of conflict, deal with the affected parties at the same time. The more they face each other, the more they will eventually get used to working with each other.
6. Choose team leaders who can act as good role models to the rest of them. For instance, you can identify some members whose behavior is excellent, as well as those who always appear to work to encourage harmony amongst co-workers. Then empower them to lead others. By so doing, the rest of the team will always look up to them and thus promoting harmony and unity in the team.
http://www.helium.com/items/1417109-how-to-build-cohesiveness-in-a-team
5. How to build cohesiveness in a team
by John Hewitt
Created on: January 17, 2010
What exactly is team cohesion and how can it be used? Very simply team cohesion is the ability of a team to stick together during a project or an exercise. When you have a high level of team cohesion truly marvellous events can take place.
In Haiti at the moment the tragic earthquake is exactly the sort of environment that needs substantial team cohesion. This will enable planning and logistics to be optimized and thus help ensure the success of the mission.
Of course at a smaller level, team cohesion is a very necessary element in the business world. I have worked in the restaurant industry and have witnessed the collapse of team cohesion - usually between the waiting staff and the chefs – which has resulted in a chain reaction of communication breakdown which finalises in poor customer service; then these customers do not return, profitability is down and the further team cohesion is compromised.
The best way to keep that all important team cohesion solid is through a union of purpose and goal setting. This can simply be carried out through a common mission statement or setting a business goal that requires all individuals to play a part. Having experienced the jealous nature of some workforces when faced with a single highly productive employee, it came to the conclusion that although individuals should be recognised there should also be a pulling together of groups as a whole to stabilise the team cohesion. Perhaps goals for all employees but only when all reach a particular level of productivity.
This of course can be implemented at the beginning of an employee’s training and in fact at the interview itself. Trying to handpick employees that really want to work for the team can be a challenge but if you can build a team based on this premise then team cohesion will be strengthened.
Of course further down the management line, team cohesion can weaken if there is a conflict of management ideas or a contradiction of requirements. This is where a good, solid, hands-on chain of command is vital. Delegation is one thing yet merely allowing lower management to run wild can be disastrous. Again I have witnessed ‘hands-off’ management that has done nothing except allow the collapse of any team cohesion.
Of course team cohesion is not just for the work place; it can be used at a family level or within a relationship. The emphasis is on a mission statement in whatever form that takes and the striving for a common goal based on trust and team work. These elements are truly the super glue of team cohesion.
Promotion of staff resiliency and
interdisciplinary team cohesion
through two small-group
narrative exchange models
designed to facilitate patientand
family-centered care
Correspondence to:
Lorraine A Dickey,
Division of Neonatology,
Lehigh Valley Hospital
and Health Network,
1200 S. Cedar Crest Blvd,
Allentown, PA 18103,
USA
Lorraine A Dickey
1,2,3
, Jack Truten
2,4
, LaDene M Gross
5
,
Lynn M Deitrick
6
1
Division of Neonatology, Lehigh Valley Health Network, Allentown, PA, USA
2
The Professional Caregivers’ Plan for Resiliency
©
3
Department of Pediatrics PFCC Initiative, Lehigh Valley Health Network,
Allentown, PA, USA
4
University of Pennsylvania School of Medicine, Philadelphia, PA, USA
5
Patient Care Services, Lehigh Valley Health Network, Allentown, PA, USA
6
Division of Community Health & Health Studies, Lehigh Valley
Health Network, Allentown, PA, USA
Abstract
Facilitated narrative exchange and reflective practice
(narrative medicine) sessions were offered at a large
community academic Magnet medical center to
promote staff education in the cultural changes
needed to successfully implement Patient- and
Family-Centered Care philosophies and 24/7 Family
Presence policies. Our models included a unit-based,
60 minutes, bi-weekly small-group session format
and a hospital-based, quarterly, 4-hour small-groupdivided
workshop format. In collaboration with the
hospital ethnographer, we developed a survey tool
and determined these sessions were well received by
physicians, nurses, and ancillary staff members alike,
regardless of their professional position or their
length of time working in health care. Participants
also reported an enhanced sense of personal resiliency,
an enhanced sense of professional team cohesion
and affiliation, and an enhanced ability to deliver
high-quality care for their patients and families.
Keywords: Narrative medicine, Reflective practice,
Patient- and Family-Centered Care, Compassion
fatigue, Burnout, Team building, Professionalism
Introduction
Patient- and Family-Centered Care (PFCC) is
described by the Institute for Patient- and Family-
Centered Care as ‘an approach to health care delivery
that redefines the relationships between and
among patients, families, and health care providers’.
The four cornerstones of the PFCC philosophy are:
Dignity and Respect, Information Sharing,
Participation, and Collaboration.
1
Enactment of
these redefined relationships among patients, their
families, and medical staff members is linked to
improved patient safety
2–4
and quality outcomes
as well as significant reduction in health care
costs.
5–7
A common initial project in implementing
this philosophy into hospital-based medical units
is the re-examination of current unit-specific
‘Visitation Guidelines’ through the lenses of patients
and their families. This often leads to the
development of ‘24/7 Family Presence Guidelines’.
While health care provider buy-in to the four
cornerstones of the PFCC philosophy is essential
to its successful implementation,
8
increased family
presence, and participation amounts to a
significant cultural shift and professional stressor,
particularly for experienced physician, nursing,
and ancillary staff members, yet this fact is often
under-appreciated. At national and international
PFCC conferences, reported barriers to successful
implementation of the PFCC philosophy and
24/7 Family Presence have included experienced
staff’s inability to make this cultural
change as quickly and thoroughly as desired by
126
© W.S. Maney & Son Ltd 2011
DOI: 10.1179/175380611X13022552566164 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
patient- and family-advisory councils and hospital
administrators.
In this article we discuss two models of a special
application of narrative medicine we describe as
‘facilitated small-group narrative exchange and
reflective practice’. With the use of specific writing
prompts these groups have been successful in proactively
addressing staff-perceived barriers to the
delivery of high-quality PFCC, particularly individual
burnout/compassion fatigue and interdisciplinary
team-cohesion/professionalism challenges.
Background
The Lehigh Valley Health Network (LVHN) is an
800-bed community academic Magnet medical
center. The Department of Pediatrics PFCC
Initiative began in May 2005 in our 28-bed, Level
IIIB, Neonatal ICU (NICU), with the establishment
of a NICU PFCC unit-based committee. Our initial
PFCC goal was to re-examine our current NICU
Visitation Policy and implement a 24/7 Family
Presence Guideline within 6 months. This was successfully
completed in two stages with parents
being welcomed to daily rounds by October 2005,
and welcomed to stay if they desired through
nursing report and change of shift in November
2005. Although formally implemented by our
experienced NICU staff, within 2 months, misgivings
associated with this significant professional cultural
change emerged that required prompt and
effective redress if 24/7 Family Presence was to be
successful in the long run. Simultaneously, 24/7
Family Guidelines were formally developed in our
pediatric ICU (PICU), In-Patient Pediatric Unit,
and in the Lehigh Valley Hospital Children’s
Clinic (out-patient unit) by their PFCC subcommittees
in early 2006: upon implementation in these
units of the 24/7 Family Presence Guidelines,
similar qualms among the staff came to light.
We developed ‘facilitated narrative exchange and
reflective practice models’ for our health care providers
as singular adaptations of Narrative Medicine
principles, as developed by Dr Rita Charon in her
pioneering work with the Narrative Medicine Core
Faculty at Columbia College of Physicians and
Surgeons. According to Dr Charon, Narrative
Medicine is medicine practiced with narrative competence
that includes the capacity to understand
stories, to see events from others’ points of view,
to recognize singular persons, and to reflect on
one’s own experience.
9–13
Three of the authors (JT,
LD, LG) received foundational training offered by
the Program in Narrative Medicine at Columbia
University to become narrative facilitators, with
two (LD, JT) completing the advanced training
course. Sands et al.
14
recently published an account
of their successful implementation of regularly
scheduled 60-minute inter-professional narrative
medicine group sessions in their Pediatric
Oncology Unit at New York Presbyterian that
demonstrated promotion of empathy and team
building, as well as prevention of burn-out in a
field of medicine that requires empathy yet invites
burn-out. Arguably, almost every domain of
today’s medical workplace inflicts similar levels of
stress and, therefore, high numbers of health care
providers are similarly at risk. Any validated
method of addressing such professional strife
should be considered, especially when well received
by interdisciplinary audiences, given that the tendency
among highly stressed professionals is to
discuss workplace difficulties mainly within their
own disciplines (e.g. physicians with physicians,
nurses with nurses, etc.),
15
if at all.
Methods
Our Department of Pediatrics PFCC Leadership
hosted a series of frank discussions with staff
members to identify why they felt it was difficult
to support the cornerstones of PFCC on a 24/7,
day-in and day-out basis. After considering
various alternatives, this multidisciplinary group
chose to adapt the narrative techniques used by
Dr Charon and others with medical students at
Columbia to our culture. This resulted in the establishment
of ‘The Professional Caregivers’ Plan for
Resiliency
©
(P-CPR
©
). The P-CPR
©
Initiative developed
two distinctive narrative medicine models:
unit-based Narrative Pediatrics and hospital-based
P-CPR
©
Narrative Medicine Workshops.
In collaboration with the hospital ethnographer,
we developed a voluntary participant survey
(LVHN Narrative Medicine Assessment Survey
©
)
with both qualitative and quantitative components
that was approved in an exempt format by
the hospital institutional review board in October
2005, and first used in November 2005. The survey
comprised an initial section that asked four basic
demographic questions. The second section consisted
of three participant opinion questions with
associated Likert scores (5 = definitely agree; 4 =
probably agree; 3 = not sure; 2 = probably disagree;
and 1 = definitely disagree). The three scored questions
were:
• Survey Q5: Today’s narrative exchange experience
was beneficial to my personal sense of
well-being/resiliency.
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
127 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
• Survey Q6: Today’s narrative exchange experience
was beneficial to my professional sense
of care team cohesion/affiliation.
• Survey Q7: Today’s narrative experience will
enhance my ability to deliver high-quality
care for my patients and their families.
The last section included three open-ended questions
for participant commentary and feedback. It
is important to note that participants could opt
out of completing the survey or could answer all,
some, or none of the survey questions.
The regularly scheduled interdisciplinary
Narrative Pediatrics sessions and P-CPR
©
Workshops
were conducted by facilitators trained in the
methods of small-group narrative exchange and
interpretation. In each 60–90-minute Narrative
Pediatrics session, the first 10 or 15 minutes were customarily
dedicated to the participants writing an
informal account of a clinical experience with a
patient, family member or colleague that was
especially stressful, challenging, or distressing, one
that significantly shaped or tested their professional
resolve – or, alternatively, of an experience that was
unusually uplifting or inspiring. For the remainder
of the session, participants simply read their narratives,
in turn, to this informed audience of colleagues,
taking advantage of this exchange to
interpret collectively the meaning and extended
implications for practice and professionalism
within each narrative. This kind of reflective-practice-in-action examines and clarifies the nature of
both professional teamwork and the constituent
components of an exemplary professional identity.
These narrative sessions are not standard support
groups, nor group therapy, nor venting sessions, in
that the scope and concerns are limited to stories
and interpretations of clinical experience. While
group members may well find the experience to be
therapeutic and/or feel supported by their colleagues,
the primary goal is to develop self and
other-awareness and insights through reflective
writing and narrative exchange. Some important
dividends of this exchange are: diminished feelings
of isolation, enhanced sense of team belonging,
sharper discernment of what patients, families,
and colleagues abide and alleviation of stress,
burnout and compassion fatigue.
Model 1: narrative pediatrics
Narrative Pediatrics is a 60-minute, bi-weekly, unitbased
small-group facilitated narrative exchange
and reflective practice model. It was established
in November 2005 and was available to any staff
or ancillary member of the in-patient pediatrics
teams to include the NICU, PICU, and In-Patient
Pediatrics.
Survey results
Demographics
Between November 2005 and October 2008, 44
Narrative Pediatrics sessions were held. All sessions
were led by at least one trained facilitator with
more than 90% of sessions led by two co-facilitators.
Average attendance was seven to eight participants.
Overall, 352 participants completed 186 surveys for
a 52.8% survey response rate. Importantly, a majority
attended two or more sessions. Most participants
(59.8%) were from the nursing profession. Other participants
included physicians (11.1%), neonatal
CRNP (6.3%) respiratory therapists (6.3%), administrative
partners (2.6%), and other (12.7%), a category
that included medical students, nursing students,
and other guests. These percentages reflect the essential
professional demographics of the department.
Fig. 1 shows all participants’ time in health care
and employment by reported position. A clear
majority of participants were experienced health
care providers. Across all surveys completed the
average reported time of working in health care
was 11–15 years with 62.9% reporting greater than
10 years and 38.6% reporting greater than 20 years.
Scored questions
Figs. 2 and 3 show reported scores by physicians
and nurses to the three scaled questions listed in
the survey by reported length of time in health
care and by number of sessions attended (once,
more than once, or more than twice). First time participants
in all disciplines felt strongly that this was a
valuable experience. Of note, this impact did not
diminish after attending second, third, or further
Narrative Pediatrics sessions. Similar scores were
reported by neonatal nurse practitioners, respiratory
therapists, support-staff members, and others such
as residents, medical students, nursing students,
and guests. A representative selection of participants’
responses to the open-ended questions is
shown in Appendix A.
Exemplary narratives from narrative pediatrics
Prompt: Write about an especially stressful or challenging
or distressing encounter with a patient,
family member, or colleague – or, alternatively,
one that was unusually inspiring or uplifting.
Response #1: From a pediatric unit nursing leader:
This experience happened many years ago (18)
when visiting hours were adhered to very
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
128 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
strictly. As I neared the end of my med pass, I
noticed a family member at the bedside of his
wife. Very politely, I reminded him that visiting
hours were over at 8:00. He stayed for a few
minutes then did leave. The next time I
worked, I learned that this visitor’s wife had
died. This situation was distressing to me. I
felt that if I had not been so strict with the visiting
hours, he would have had more time to
spend with his wife.
Response #2: From a pediatric respiratory therapist
with over 15 years of experience:
In with the good, out with the bad is a deceptively
simple idea. In fact, it’s really complex – and
maybe even closer to E = MC
2
. What happens
if you cannot bring in the good … and the bad
cannot be pushed out …
– It is very obvious that the simple act of breathing
is not so simple. Not as easy as ABC:
Airway/Breathing/Circulation …
– Not so easy really. Watching helplessly, and
hoping something gets easier. Sometimes I
wish such things were more like 1 + 1 = 2, just
like breathing should be easy as 1 . 2 . 3. But
I’m not very good at math.
When asked later to reflect on this narrative the
author commented:
Figure 1: Narrative pediatrics: all survey responses to time in health care.
Figure 2: Narrative pediatrics: physician responses to Likert scale questions.
Figure 3: Narrative pediatrics: nurses (RN) responses to Likert scale questions.
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
129 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
I remember writing that like it was yesterday
and all of those emotions come flooding back.
I will never forget that patient or that day.
Thanks for the opportunity to write this and
get the frustration out. I am able to keep up
with this patient’s condition and the struggle
is getting easier for the patient.
Model 2: P-CPR
©
workshops
Our Professional Caregivers’ Plan for Resiliency
©
(P-CPR
©
) workshops are 4-hour, quarterly, smallgroup-divided, hospital-based facilitated narrative
exchange and reflective practice sessions. These
workshops are open to any member of the hospital
staff.
This workshop series began in June 2006 on the
staff-requested topic of: ‘Stress, Burnout, and
Compassion Fatigue with Tools for Stress
Management’ (SB/CF). The format included an
opening plenary session covering the nature and
effects of workplace stress, burnout, and compassion
fatigue followed by an extended (2 hours)
small break-out groups narrative writing and interpretive
exchange sessions on this topic.
The workshop concluded with a key facilitator
discussing stress management tools including
guiding participants through a short meditation
exercise. Unsure of their initial reception, we conceived
of these early workshops as a pilot
program. Between June 2006 and February 2007,
74 staff members participated in four pilot SB/CF
workshops. Informal participant reviews were
strongly positive. In March 2007 IRB approval
(exempt status) was requested and granted so we
could apply our LVHN Narrative Medicine
Assessment Survey
©
to all future narrative medicine
initiatives including our P-CPR
©
workshops.
As noted by Sands et al., narrative medicine
techniques have been previously applied to staff
burnout and compassion fatigue difficulties. It was
unknown to us, however, whether our special adaptation
of narrative exchange could successfully be
applied to other critical staff-identified barriers to
PFCC implementation. During the SB/CF workshops,
a number of staff members reported that
troubled team dynamics were interfering significantly
with their ability to deliver high-quality
care. In response to this concern we developed a
second workshop: ‘Interdisciplinary Team-
Building and Professionalism with Tools for
Conflict Management’ (TB/P), with a format
similar in design to the first workshop. The
opening plenary session covered the concepts of
professionalism and conflict in the workplace. An
extended narrative writing and interpretive
exchange session (2 hours), again in break-out
groups, followed the plenary presentation and the
workshop concluded with a key facilitator discussing
conflict management tools which included
guidance through clinical conflict management
scenarios.
Survey results
Demographics
Between March 2007 and March 2008 10 P-CPR
©
workshops were conducted including 5 SB/CF and
5 TB/P. Of these, 90% were co-led by three trained
narrative medicine facilitators, and all were led by
at least two. The number of participants per
session ranged from 8 to 30. A total of 156 participants
came to these 10 workshops and completed
155 surveys (99.3%). The five SB/CF workshops
yielded 78 completed participant surveys while the
five TB/P seminars had 77 completed participant
surveys. Participants registered from the following
LVHN hospital units: PACU, TNICU, MICU,
SICU, ED, OR, Burn, Trauma, adult in-patient
medical units, and patient care specialists from all
clinical areas, in addition to representatives from
all areas of pediatrics – in-patient pediatrics,
NICU, PICU, out-patient pediatrics, and pediatric
subspecialty clinic staffs. Participants were asked
to identify themselves by profession. The majority
of those who attended were from nursing with
other professions identified as shown in Table 1.
Fig. 4 shows participants reported length of
employment in both the SB/CF and TB/P workshops.
Across all surveys completed, the average
reported time working in health care was 16–19
years with nearly 50% reporting more than 20
years in health care. In the SB/CF workshops,
71.8% reported having greater than 10 years in the
health care profession and 46.2% had more than
20 years. In the TB/P workshops, 66.7% reported
having greater than 10 years or more in the health
Table 1: Participants in each workshop by profession.
Profession
SB/CF
workshop (%)
TB/R
workshop (%)
Nursing 85.9 59.7
Physicians 0 1.3
Nurse practitioner 0 1.3
Respiratory
therapist
1.3 6.5
Administrative
support
0 1.3
Other 12.8 29.9
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
130 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
care profession and 48.7% reported having more
than 20 years.
Scored questions
Fig. 5 shows all participants’ reported responses to
the three Likert scale scored questions listed in the
survey by the type of workshop attended (SB/CF
or TB/P). Of note, 85.9% of participants were
from the nursing profession. P-CPR
©
workshop
responses to open-ended questions are shown in
Appendix B.
Exemplary narratives from P-CPR workshops
Prompt (SB/CF): Write about an especially stressful
or challenging or distressing encounter you had
with a patient or family member – or, alternatively,
one that was unusually inspiring or uplifting.
Exemplary narrative response: Nurse from adult
NeuroSciences unit:
RN for 36 yrs. Last week young female patient –
symptoms of inoperable brain tumor. Such
familiar symptoms. Paralyzed vocal cords
with soft voice unable to express so many
needs and emotions. The look on her mother’s
face and the terror. Hopefulness of husband
because she was in a trial medication study at
a ‘major’ hospital (they don’t always work).
Patient knows she is dying – can tell by the
look in her eyes. My friends and co-workers
of over 20 years understand the tears in my
eyes and why they are there. Just having them
know helps.
This author later commented:
I work in the neuroscience ICU so there are
always patients with many and severe symptoms
but this one especially touched me as
her symptoms were exactly like my 31 year
old son who passed away in 2006. My coworkers,
fortunately, are all very supportive
when I have a bad day.
Prompt (TB/P): Write about an especially stressful or
challenging or distressing encounter with a
Figure 4: P-CPR
©
SB/CF and TB/P workshops: all survey responses to time in health care.
Figure 5: P-CPR
©
SB/CF and TB/P workshops: all survey responses to Likert scale questions.
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
131 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
colleague or colleagues – or, alternatively, one that
was unusually inspiring or uplifting.
Exemplary narrative response: Physician from
Neonatal Intensive Care Unit
Another difficult long-term surviving baby
with a history of extreme prematurity (24
wks), and pulmonary failure … unexpectedly
for reasons I don’t understand, she made a significant
improvement over about 10 days, and
presented [us] with a window of opportunity
for extubation. A gift perhaps … She did well
for a few hours, then deteriorated. [Her]
parents chose not to reintubate but did arrive
to hold her as she passed away.
As I was going through her chart complete with
115 days of life and medical history … a seasoned
NICU RN (not involved with this baby)
stood in the doorway of the Team Room – me
at the table surrounded by charts and papers
and her in her scrubs and judgment. She
waited for me to pause, and said, ‘You know,
you knew that baby would die when you
extubated her, didn’t you?’ in a way I clearly
interpreted as ‘you exubated that baby
and hastened her death.’ I felt judged by
someone who clearly did not have to make
these types of decisions but felt it was okay
to give such criticism at a time when I was
professionally grieving – that’s what happens
when you sift through a chart to do a death
summary.
Discussion
We undertook the establishment of a PFCC initiative
within a community academic medical center and
adopted the philosophy that staff members need
to be respected and educated as key stakeholders
in the delivery of PFCC. We felt it was imperative
to offer proactive and on-going educational
forums to assist staff members in this inevitable
but challenging professional transition to 24/7
Family Presence. These evaluated pilot P-CPR
©
narrative exchange models, Narrative Pediatrics and
P-CPR
©
Narrative Medicine Workshops, demonstrate
that both are effective and highly valued by new
and experienced health care professionals alike in
addressing identified barriers to the delivery of
high-quality professional care to patients and
families. Comments from surveys show participants
overwhelmingly find these sessions helpful in
processing stress and developing team cohesiveness.
These models also validate the use of
facilitated narrative exchange group techniques
outside academic medical environments and with
experienced health care providers. The models,
further, support the proposition of Sands et al. that
narrative training for interdisciplinary groups of
health care professionals may be a promising
method for improving both the clinical care
provided and the lived experiences of the
professionals.
When health care professionals of all categories
perceive fewer obstructions to delivering the type
of high-quality care they want to provide, higher
patient and family satisfaction scores, and improved
staff retention rates (especially for nursing) are likely
to follow. The higher proportion of workshop participants
from nursing may reflect the availability
of CEUs through LVHN’s Division of Education.
CME was not available during this time and this
may have been a barrier to physician participation
in the half-day workshops.
Future investigations will convene focus groups
of former narrative group participants to gauge
their ability to translate experience in the narrative
sessions into enhanced care at the bedside.
Additionally, we plan to survey staff estimates of
the extent to which such narrative exchange experiences
facilitate interdisciplinary agreement about
patient safety, medical errors, and collaboration
on questions of retention, attrition, and interprofessional
relations.
Conclusion
Facilitated narrative exchange and reflective practice
group sessions were well received by health care
staff participants regardless of professional position,
length of time working in the health care field, or
how many sessions were attended. Participants
also perceived enhancements in their personal
sense of resiliency, their sense of professional team
cohesion and affiliation, and their ability to deliver
high-quality care for their patients and the families.
This efficient and effective adaptation of narrative
medicine – with appropriately trained facilitators –
could easily be applied in other specialties and in
other medical facilities, and there further tested
and assessed with our survey tool. To our knowledge,
this approach and assessment have not been
previously included in extant interdisciplinary
studies.
Acknowledgements
The authors would like to acknowledge Narrative
Pediatrics is supported by separate $1500
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132 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
educational grants from both Ross Products, division
of Abbott Laboratories, and MedImmune,
Inc. (consultant fee support and lunches provided).
Our thanks to Mr Joseph Zarola from Ross
Products and Ms Barbara Clouden, RRT, from
MedImmune, Inc., for their continuing support of
this important initiative.
The Professional Caregivers’ Plan for Resiliency
(P-CPR
©
) Narrative Medicine Workshops are supported
by a $15 000 2-year grant from the Anne
Anderson Trust, Leonard and Dorothy Poole
Foundation.
The authors would also like to acknowledge Carol
Sorrentino for her devotion to this initiative as a Key
Facilitator for all the P-CPR
©
Stress, Burnout, and
Compassion Fatigue Workshops.
All authors had full access to all of the data in the
study and take full responsibility for the integrity of
the data and the accuracy of the data analysis. There
are no potential conflicts of interest, financial interests,
or relationships relevant to the subject of this
research.
The authors also extend their gratitude of the
writers of the exemplary narratives who gave their
approval to publish their narratives in the expressive
formats displayed in this article.
Appendix A: open-ended questions
and comments – platform 1
Narrative pediatrics participant responses
RN < 1 year in healthcare
1. I think having these sessions will really cut
back on nurses ‘burn out’. Keep up the good
work!
2. Excellent service for employees, thank you!
RN 1–2 years in healthcare
1. I think it help(s) me to identify what has been
holding me back and not allowing myself to be
the RN I want to be.
2. Thank you for listening and never judging any
of us.
3. Small group led to more specific and interactive
experience.
4. I think it is a great way to share stories that
deeply affect us and is a way to get great feedback
on our own prescription of our professional
care.
5. Since it is somewhat difficult for family and
friends to relate to healthcare issues, this is a
wonderful forum for us to commiserate and
learn.
RN 3–4 years in healthcare
1. The opportunity to share ideas and concerns
and have other similar experienced people
review it, offer their ideas can help to cope
and correct situations.
2. It helps me to feel validated and that some of
my feelings I wonder if I am overreacting, I
feel like I make sense of it.
3. It made me feel that our unit is more unified
that I sometimes realize.
4. Allowing us to identify and work emotionally
through our professional challenges in our
unit.
RN 5–10 years in healthcare
1. Able to speak about how I really feel. I’m glad
to realize that people feel how I feel and that
their perspective helps me.
2. Reminds me of why we do what we do.
3. It was very helpful to hear from my fellow colleagues
that they share the same feelings as I
do. It helps to know I am not alone.
RN 11–15 years in healthcare
1. This certainly gives one a sense of ‘allowance’
for the feelings we have and often harbor.
2. Allows you to feel that what you are feeling is
normal. Brings everyone to the same playing
level.
RN 16–19 years in healthcare
1. It is very valuable to exchange experiences
with other people who ‘understand’.
2. It allows me to express these important, deep
feelings without judgment.
3. Allows me to routinely ‘self-check’ how I am.
4. Highly valuable, increases my self-awareness
each time I come!
RN > 20 years in healthcare
1. I was so wrapped up with my thoughts of my
terrible night that it was changing the way I
look at things, and cared for my patients in a
negative way. After the narrative medicine
session I felt power, relief, support, and now
functioning positively as I realistically look at
that terrible night.
2. Gives me a reminder of how everything we
do has an impact, sometimes more than we
think.
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133 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
3. I come away from every session with something
new to help my personal and professional
care.
4. I really enjoy hearing from different disciplines
we are all the same in our feelings and
experiences.
5. Good to talk among health care professionals.
Lowers my blood pressure!!
6. To know and realize that experiences effect my
peers in similar ways is helpful.
Physicians 3–4 years in health care
1. Helpful to get insight from experienced colleagues;
they can understand better.
Physicians 5–10 years in health care
1. Very nice time to decompress.
2. To build sense of ‘support’ within our care
team in order to get through the tough cases.
3. Valuable to know people share same struggles.
4. Good to talk and get some feedback on my
emotions.
5. Have a brief course given to incoming residents
day orientation.
Physicians > 20 years in healthcare
1. I thought it definitely helped enhance my attitude
about the care I am delivering.
2. It helped to hear that we all have similar problems.
Release of pent up feelings.
3. I always feel lighter.
4. Increased number of participants from different
areas i.e. MD, RN, RRT, nutrition, pharmacy,
PT, OT.
CRNP 5–10 years in healthcare
1. Valuable and it allows a safe environment to
deal with issues that are bothering us or personal
concerns that would like to be shared.
2. Gives a better understanding of my coworkers’
thoughts/feelings.
3. Pleasant time in work day. Able to relax, share,
listen, learn, grow.
CRNP 16–19 years in healthcare
1. It definitely allows for self-appraisal/
reflection.
2. That it has the potential to reshape how I practice
and live in my profession.
CRNP 16–19 years in healthcare
1. Great place to share feelings. I live
alone and do not get a chance to tell my
work stories.
2. It adds, improves, expands, and enlightens.
Respiratory therapist <1 year in healthcare
1. Wonderful exchange of ideas.
Respiratory therapist >20 years in health care
1. Gives me a reminder of how everything we
do has an impact, sometimes more than we
think.
2. Thanks for help getting this off of my chest.
3. This was excellent. I will attend other
sessions.
Others < 1 year in health care
1. At this point I am still learning about how this
will benefit my future experiences as a clinician.
I see great value in it.
2. It was helpful to encourage me to reflect on
every experience.
3. It makes you think about different ways to
handle different situations.
Others 1–2 years in health care
1. I think it helps me remember to try and listen
to the whole of a patient, family, and/or
health care team member story.
Others 3–4 years in health care
1. It was good to get at anger and sadness. I feel
better now. Thanks!
2. I think it made me aware of my present attitude
and defense mechanisms I use.
Others 11–15 years in health care
1. I am hoping that as the sessions continue that
many more pediatrics staff members will participate.
Personally I would like to continue
to attend, even though I probably will not
have anything to share on an on-going basis.
I just like listening to the stories and offering
support. I find it beneficial to attend because
I work closely with the doctors and staff
albeit in a different way. I see how their daily
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134 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
jobs affect them. It gives me renewed
respect for them and what they do on a daily
basis.
Others > 20 years in healthcare
1. Such a simple act of (writing, reading) yet so
powerful and healing.
2. It is valuable to review all of our perspectives,
real issue seems to me to be how to respect
them.
Appendix B: Open-ended questions
and comments – platform 2
PCPR workshop participant responses
Compassion fatigue, resiliency and burnout
seminars
RN 5–10 years in health care
1. This is too valuable to pass up. This will
definitely enhance my caregiving. This
session mainly has helped me to understand
myself.
2. This session will make me a better nurse,
better co-worker, and better overall human
being.
3. This is the 1st time I have heard about narrative
medicine and it was exceptional. The whole
presentation was well worth the time. There
should be more of these.
4. Excellent. I not only learned about myself but
others and their experiences. I really feel we
are all in the same boat.
5. I am a person who does not like to talk in
groups like this, so it was hard but I think
over all it was a good experience.
RN 11–15 years in health care
1. Very helpful. It was beneficial to listen to other
stories and know that they go through the
same challenges/difficulties that I do. Thank
you for including a physician in this experience
also.
2. Helps to understand why some families/
patients respond the way they do.
3. I think it is a wonderful way of us listening to
our coworkers and some of the ‘blocked’ feelings
we all experience through out our
careers/experiences and in cooperating with
daily life/family.
RN 11–15 years in health care
1. I would want all my staff to attend this session.
2. Have them more often so more staff can attend,
or train other facilitators so that more staff has
access – been at the unit level.
3. The narrative medicine session was great. I
really related to what other people were
saying and they related to me. It was very
satisfying.
RN > 20 years in health care
1. Excellent, I have never experienced anything
quite like this. I have been to many programs
set up to be similar to this, but I never felt like
anything was accomplished. It is good to see
that other units experience a great deal of
stress too!
2. Learned through many others professional
experiences. Excellent experience!
3. I think it definitely allows you to get in touch
with yourself and to know our profession is
really challenging.
4. I really think they could benefit all departments.
We always should try and improve
patient care and working better with our coworkers
will do that. We should continue
team growth frequently.
5. Opening myself can only help healing
ourselves and providing awareness
to others.
6. Nice to share experiences and get validated
by peers.
7. Even though I thought my situation to be unit
specific – it was great to have it validated by
peers and management alike.
8. Thought should be given having these sessions
for struggling units, new hires, e.g.
staffed units, etc.
9. A way to express and articulate what your
experiences have been. Validate actions and
also causes you to take a moment and consider
if something could have been done
differently.
10. I realize that there are others about me with
the same if not worse experiences than me.
11. This helped me put my experience in
perspective.
Team-building and professionalism seminars
RN 3–4 years in health care
1. Greatly enhances self-worth which in turn
allow me to maintain a positive and professional
manner in my care of patients.
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
135 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
RN 5–10 years in health care
1. Greater insight to positive and negative experiences
that impact teamwork.
2. Themes always seem to become uncovered
or brought to light. Very interesting that it
happens unconsciously.
3. Therapeutic. Provides an outlet when sharing
narratives and provides valuable sense of
support/validity.
4. We are our own worst critics and those we
work with are our best listeners when it
comes to dealing with workplace stress. I
value the ability of my peers to listen, react,
not judge, and be compassionate about my
feelings and theirs.
5. Thank you for allowing me to be me and
express myself with confidentiality.
RN 11–15 years in health care
1. It allows you to reflect and also realize
you are not alone – everyone tells a similar
story.
RN 16–19 years in health care
1. It is most inspiring to hear other stories
and to see how other people handled certain
situations. It gives you ideas in how to
deal with people and situations that are
currently happening or will happen in the
future.
2. Sharing common experiences with other
members of the health care team gives wonderful
insight and commonality.
3. I will plan to send additional RN’s/professionals
from my unit.
Physician 16–19 years in healthcare
1. It probably works with certain people.
Personally, I do not think it works for me. I
have a different way of coping (Note: this physician
noted listening to RN writings and hearing
their perspectives were very worthwhile and
important even though the narrative component
was not felt to be helpful.).
Others 5–10 years in health care
1. It was good to hear other people’s personal
experience to know you are not alone.
2. Found it was very good to hear I was not the
only one feeling some sort of way.
Others 16–19 years in health care
1. It showed that everyone is human. We all have
our ups and downs, but the point is we all are
in this together.
2. Exceptionally well done. The facilitator helped
clarify opened up lines of communication.
Others > 20 years in health care
1. Very well run – our facilitator was excellent! Very
beneficial to my role as resource specialist and as
a mom, wife, daughter etc. in my personal life.
Was not really sure what this was going to be
about – it was just ‘strongly recommended’ that
I attend. I am so glad that I did. Even after 12
hours of work – I was not tired – therefore a successful
conference – Great job!
2. Different viewpoints really help to examine
personal situations. Informative, interesting,
emotional.
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Author information
Lorraine A Dickey, MD, MBA, FAAP, is a senior clinical
neonatologist and is currently the Chief, Division of
Neonatology, and the Medical Director of the Nursery
ICU at Lehigh Valley Health Network. She earned her
MBA in Health Care Management in 2006 from Regis
University, completed Narrative Medicine Facilitator
training in 2007, and Advanced Narrative Medicine
Facilitator training in 2008 with Dr Rita Charon and
the Narrative Medicine Core Faculty at Columbia
College of Physicians and Surgeons. Along with Jack
Truten, in 2005 she co-founded of The Professional
Caregivers’ Plan for Resiliency, an interdisciplinary grassroots
approach that addresses operational barriers to
the successful implementation of Patient- and Family-
Centered Care.
Jack Truten, RN, PhD, has received formal training in
clinical ethics (fellowship, Lehigh Valley Health
Network), and in Narrative Medicine (foundational and
advanced levels, Columbia University). Dr Truten is currently
Director of Professionalism Education at the
University of Pennsylvania School of Medicine where he
trains faculty and leads seminars for house staff in
‘Narrative Professionalism’.
LaDene M Gross, RN, MSed, Administrator, Patient Care
Services, is a registered nurse with more than 35 years
experience encompassing direct patient care, education,
and leadership responsibilities in an acute care facility.
Current responsibilities include administrative oversite
for labor and delivery and mother baby clinical areas
(more than 3900 deliveries per year). She is administratively
responsible for pediatrics, pediatric intensive care,
and neonatal intensive care patient care units. LaDene
has experience with team building, facilitation, and
project development and has completed Narrative
Medicine education and participant in Patient Family-
Centered Care, Narrative Pediatrics, and Professional
Caregivers’ Plan for Resiliency initiatives and programs.
Lynn M Deitrick, RN, PhD, is a Medical Anthropologist/
Ethnographer, Division of Community Health & Health
Studies, LehighValley Health Network in Allentown,
PA. She is a qualitative research expert and has numerous
publications and presentations on the use of qualitative
methods in nursing, health research, patient satisfaction,
and quality of care. Her research interests include cultural
awareness, health disparities, patient satisfaction, quality
of care, and the application of qualitative methods for
use in the clinical setting.
Dickey et al. – Promotion of staff resiliency and interdisciplinary team cohesion
138 Journal of Communication in Healthcare 2011 VOL. 4 NO. 2
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